Risk of Lymphohematologic Malignancies in Chronic Plaque Psoriasis Journal of the American Academy of Dermatology

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• In this systematic review of 20 observational studies comprising over 2.5 million patients, a significantly increased risk of lymphohematologic malignancies (HR, 1.55) and lymphoma (HR, 1.27) was found in patients with moderate to severe plaque psoriasis compared with the general population. Cutaneous T-cell lymphoma was associated with the highest risk in psoriasis patients (HR, 6.22). Increased risk of Hodgkin lymphoma (HR, 1.71), non-Hodgkin lymphoma (HR, 1.27), multiple myeloma (HR, 1.32), and leukemia (HR, 1.28) was also found in psoriasis patients.

• Moderate to severe psoriasis is associated with increased risk of lymphoma and leukemia, particularly cutaneous T-cell lymphoma.

–  Kelly B. Scarberry, MD

Written by

 

 

Jeffrey M. Weinberg MD

From the beginning of the biologic era, the concern about malignancy in the setting of biologic therapy for psoriasis has been a consideration. Early in this period, the focus was on tumor necrosis factor blockers, and a potential association with lymphohematologic malignancies (LHMs). The debate over this association was if it was due to pharmacologic intervention versus the sustained immune activation of the underlying psoriasis.

Bellinato et al performed a systematic review and meta-analysis of observational cohort studies in order to assess the association of psoriasis with different LHMs. The authors selected a total of 25 observational studies, comprising collectively 2,501,652 subjects. A significantly increased risk for LHM (HR, 1.55; 95% CI, 1.24–2.94) and lymphoma (HR, 1.27; 95% CI, 1.08–1.50) in patients with moderate to severe plaque psoriasis compared with the general population was found. In particular, the investigators found increased risks for Hodgkin lymphoma (HR, 1.71; 95% CI, 1.27–2.30), non-Hodgkin lymphoma (HR, 1.27; 95% CI, 1.08–1.50), multiple myeloma (HR, 1.32; 95% CI, 1.03–1.69), and leukemia (HR, 1.28; 95% CI, 1.00–1.65). In addition, the risk of cutaneous T-cell lymphoma was markedly augmented in patients with psoriasis (HR, 6.22; 95% CI, 3.39–11.42).

The authors concluded that the increased risk of LHMs, particularly cutaneous T-cell lymphoma, in patients with psoriasis could be related to exposure to systemic immunosuppressive therapies, comorbidities, and sustained immune activation, particularly in the skin.

This study is a further confirmation of our understanding of the risk of LHMs, which have multiple possible etiologies. The association of cutaneous T-cell lymphoma is of note, and prospective patients should be followed clinically accordingly. Given the findings of this study, patients who are treated with biologics should be counseled concerning these risks.

BACKGROUND

The association between chronic plaque psoriasis and lymphohematologic malignancies (LHMs) remains controversial.

OBJECTIVE

To investigate the risk of LHMs in patients with psoriasis according to the best evidence.

METHODS

A systematic review and meta-analysis of observational cohort studies was undertaken to assess the association of psoriasis with different LHMs. A literature search for relevant studies was performed on February 28, 2021. The random-effects model in conducting meta-analyses was applied. To evaluate the risk of bias, the Newcastle-Ottawa Scale was employed.

RESULTS

A total of 25 observational studies were selected, comprising collectively 2,501,652 subjects. A significantly increased risk for LHM (hazard ratio [HR], 1.55; 1.24-2.94) and lymphoma (HR, 1.27; 1.08-1.50) in patients with moderate-to-severe plaque psoriasis compared to the general population was found. In detail, increased risks for Hodgkin lymphoma (HR, 1.71; 1.27-2.30), non-Hodgkin lymphoma (HR, 1.27; 1.08-1.50), multiple myeloma (HR, 1.32; 1.03-1.69), and leukemia (HR, 1.28; 1.00-1.65) were found. The risk of cutaneous T-cell lymphoma was markedly augmented in patients with psoriasis (HR, 6.22; 3.39-11.42).

LIMITATIONS

Possible ascertainment bias related to the diagnosis of LHMs.

CONCLUSION

The increased risk of LHMs, particularly cutaneous T-cell lymphoma, in patients with psoriasis could be related to exposure to systemic immunosuppressive therapies, comorbidities, and sustained immune activation, particularly in the skin.

Journal of the American Academy of Dermatology

Risk of Lymphohematologic Malignancies in Patients With Chronic Plaque Psoriasis: A Systematic Review With Meta-Analysis

J Am Acad Dermatol 2021 Aug 04;[EPub Ahead of Print], F Bellinato, P Gisondi, G Girolomoni 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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