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Celiac.com 04/13/2010 - A team of clinicians recently described a case of immune modulation by non-Hodgkin lymphoma in a patient with two primary intestinal T-Cell lymphomas and long-standing celiac disease. F. MuÌˆhr-Wilkenshoff, M. Friedrich, H. D. Foss, M. Hummel, M. Zeitz, and S. Daum made up the research team. They are variously affiliated with the Medical Clinic I, Gastroenterology, Rheumatology and Infectious Diseases, and with the Department of Pathology, Charité of the Campus Benjamin Franklin of University Medicine Berlin, Germany. About 20–30% of all non-Hodgkin lymphomas (NHLs) are gastrointestinal in nature. Of these gastrointestinal lymphomas, about 20–30% occur in small intestine The clinical team recently reported the case of a 72-year-old patient who had been diagnosed with celiac disease when he was 52-years old. The man had not followed a gluten-free diet, yet showed no evidence of enteropathy or celiac-associated antibodies, but still developed a jejunal T-cell lymphoma. Doctors resected the lymphoma due to perforation and treated the patient with four courses of IMVP-16. The patient began and maintained a strict gluten-free diet. Two years later, the patient appeared with weight loss and a clonally divergent refractory sprue type II with loss of antigen (CD8; T-cell receptor-) expression in intraepithelial lymphocytes. At this time, he showed high titers of celiac-associated antibodies, although he was on a strict GFD. The research team notes that the missing enteropathy under a gluten-containing diet supports the idea of immune suppression in malignant diseases, especially non-Hodgkin lymphoma. They also note that the fact that, even while maintaining a strict gluten-free diet, the patient developed refractory sprue type II, an early form of another independent T-cell lymphoma, along with celiac-associated antibodies, suggests that clonal intraepithelial lymphocytes might be stimulating antibody production. Thus, they conclude that isolated detection of celiac-associated antibodies in patients with celiac disease does not prove that patients have deviated from their gluten-free diets. Source: Digestion 2010;81:231–234 DOI: 10.1159/000269810
Eur J Gastroenterol Hepatol 2006;18:187-194. Celiac.com 04/10/2006 - According to findings by Dutch researchers, celiac disease increases the risk of non-Hodgkin lymphoma—but to a lower level than once believed. Past celiac disease studies have indicated that there is a 30 to 40-fold increased risk of enteropathy-associated T-cell lymphoma, however, Dr. M. Luisa Mearin and colleagues in The Netherlands investigated the frequency of celiac disease in two large European populations—one was a control group and the other was a group of non-Hodgkin lymphoma patients—and found that 1.2% of the non-Hodgkin lymphoma patients had celiac disease compared to 0.5% of the controls. After adjusting for age and sex differences between the two groups they found that celiac disease patients had a 2.6-fold increase risk of getting non-Hodgkin lymphoma, and this increased risk was only associated with patients who had been diagnosed prior to the study, and not in those with “silent” celiac disease which was found during the study. The odds of T-cell type small bowel lymphoma in celiac disease patients was estimated to be 28 times higher than for other localizations. The researchers conclude that celiac disease patients have a significantly increased risk of developing non-Hodgkin lymphoma, but the association is lower than previously thought. Celiac disease is mainly associated with T-cell small bowel lymphoma which is, in general, a rare condition.
JAMA 2002;287:1413-1419. Celiac.com 04/12/2002 - According to a report published in the March 20th issue of the Journal of the American Medical Association, people with celiac disease are three times more likely to develop non-Hodgkin lymphoma (NHL) than the normal population. Dr. Carlo Catassi and colleagues from the University of Maryland in Baltimore compared the prevalence of celiac disease in 653 NHL patients with more than 5,000 healthy control subjects to determine the NHL-celiac disease occurrence rate. The results indicate that 1% of NHL patients also have celiac disease, in comparison with 0.42% of the healthy controls. Adjustments were made for age and sex, and the final results indicate that the odds ratios for a patient with celiac disease of developing NHL are: 3.1 for all types of NHL, 16.9 for gut NHL, and 19.2 for T-cell NHL. The overall risk, however, for someone with celiac disease developing NHL is only 0.63%. The researchers do not feel that their findings support mass screening for celiac disease, but they do feel that selected NHL patients should be screened for celiac disease. We would also like to add that these findings support the screening of people with celiac disease for NHL, which was not directly addressed by the report.