European Journal of Epidemiology

, Volume 28, Issue 6, pp 475–483

Does celiac disease influence survival in lymphoproliferative malignancy?

  • Jonas F. Ludvigsson
  • Benjamin Lebwohl
  • Alberto Rubio-Tapia
  • Joseph A. Murray
  • Peter H. R. Green
  • Anders Ekbom
  • Fredrik Granath
CANCER

DOI: 10.1007/s10654-013-9789-8

Cite this article as:
Ludvigsson, J.F., Lebwohl, B., Rubio-Tapia, A. et al. Eur J Epidemiol (2013) 28: 475. doi:10.1007/s10654-013-9789-8

Abstract

Celiac disease (CD) is associated with both lymphoproliferative malignancy (LPM) and increased death from LPM. Research suggests that co-existing autoimmune disease may influence survival in LPM. Through Cox regression we examined overall and cause-specific mortality in 316 individuals with CD+LPM versus 689 individuals with LPM only. CD was defined as having villous atrophy according to biopsy reports at any of Sweden’s 28 pathology departments, and LPM as having a relevant disease code in the Swedish Cancer Register. During follow-up, there were 551 deaths (CD: n = 200; non-CD: n = 351). Individuals with CD+LPM were at an increased risk of death compared with LPM-only individuals [adjusted hazard ratio (aHR) = 1.23; 95 % confidence interval (CI) = 1.02–1.48]. However, this excess risk was only seen in the first year after LPM diagnosis (aHR = 1.76), with HRs decreasing to 1.09 in years 2–5 after LPM diagnosis and to 0.90 thereafter. Individuals with CD and non-Hodgkin lymphoma (NHL) were at a higher risk of any death as compared with NHL-only individuals (aHR = 1.23; 95 % CI = 0.97–1.56). This excess risk was due to a higher proportion of T cell lymphoma in CD patients. Stratifying for T- and B cell status, the HR for death in individuals with CD+NHL was 0.77 (95 % CI = 0.46–1.31). In conclusion, we found no evidence that co-existing CD influences survival in individuals with LPM. The increased mortality in the first year after LPM diagnosis is related to the predominance of T-NHL in CD individuals. Individuals with CD+LPM should be informed that their prognosis is similar to that of individuals with LPM only. However, this study had low statistical power to rule our excess mortality in patients with CD and certain LPM subtypes.

Keywords

CancerCeliacCoeliacDeathLymphoproliferativeMalignancy mortality

Abbreviations

CD

Celiac disease

CI

Confidence interval

HR

Hazard ratio

VA

Villous atrophy

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Jonas F. Ludvigsson
    • 1
    • 2
  • Benjamin Lebwohl
    • 4
  • Alberto Rubio-Tapia
    • 3
  • Joseph A. Murray
    • 3
  • Peter H. R. Green
    • 4
  • Anders Ekbom
    • 1
  • Fredrik Granath
    • 1
  1. 1.Clinical Epidemiology Unit, Department of MedicineKarolinska University Hospital, Karolinska InstituteStockholmSweden
  2. 2.Department of Pediatrics, Örebro University HospitalÖrebro UniversityÖrebroSweden
  3. 3.Division of Gastroenterology and Hepatology, Department of MedicineMayo Clinic College of MedicineRochesterUSA
  4. 4.Celiac Disease Center, Department of MedicineColumbia University College of Physicians and SurgeonsNew YorkUSA