Patients with moderate to severe plaque psoriasis may be at an increased risk for developing lympho-hematological malignancies, according to research findings published in the Journal of the American Academy of Dermatology.
In addition to psoriasis, lympho-hematological malignancies have been associated with other chronic immune-mediated inflammatory diseases such as systemic lupus erythematosus, rheumatoid arthritis, and dermatomyositis. In a recent meta-analysis, researchers from Italy evaluated the association between psoriasis and lympho-hematological malignancies in 25 observational cohort studies.
A total of 12 studies included data for any unspecified lymphoma, and 5 studies provided data for any unspecified hematological malignancy. The number of studies that focused on Hodgkin lymphoma, non-Hodgkin lymphoma (NHL), and cutaneous T-cell lymphoma (CTCL)/mycosis fungoides (MF) were 6, 12, and 7, respectively. Collectively, the pooled cohort comprised 2,501,652 patients.
The majority of patients in the studies had moderate to severe psoriasis, but 3 of the 25 studies assessed the risk for lympho-hematological malignancies in patients with mild psoriasis. Most studies had an average follow-up period of 5 or more years, with follow-up ranging from 1.5 years to 30 years.
Overall, patients with psoriasis in these studies had a significantly increased risk for Hodgkin lymphoma (hazard ratio [HR], 1.71; 95% CI, 1.27-2.30), NHL (HR, 1.27; 95% CI, 1.08-1.50), and CTCL/MF (HR, 6.22; 95% CI, 3.39-11.42). There was also a significant association between psoriasis and the risk for multiple myeloma in 2 studies (HR, 1.32; 95% CI, 1.03-1.69) and leukemia in 8 studies (HR, 1.28; 95% CI, 1.00-1.65).
According to the investigators, the increased risk for malignancies “in patients with psoriasis could be related to the exposure to systemic immunosuppressive therapies, comorbidities and sustained immune activation, particularly in the skin.”
Possible ascertainment bias related to the diagnosis of LHM was cited by the study authors as a study limitation.
Given the more severe inflammatory burden associated with moderate to severe psoriasis, the researchers added that their findings from this analysis underscore “the need of special attention for emergence of cutaneous lymphoma in patients with psoriasis.”
Disclosure: Several authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.
Bellinato F, Gisondi P, Girolomoni G. Risk of lympho-hematologic malignancies in patients with chronic plaque psoriasis: A systematic review with meta-analysis. J Am Acad Dermatol. Published online August 4, 2021. doi:10.1016/j.jaad.2021.07.050