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Erschienen in: Wiener klinische Wochenschrift 21-22/2013

01.11.2013 | original article

Diagnosing celiac disease in patients with a history of lymphoma: factors that matter

verfasst von: Karel Balihar, Jana Kozeluhova, Vaclav Hejda, Michal Krcma, Daniel Lysak, Jitka Gorcikova, Ondrej Hes, Martin Matejovic

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 21-22/2013

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Summary

Objective

The aim of this study was to identify pitfalls in establishing the diagnosis of celiac disease (CD) in patients with a history of lymphoma.

Methods

A total of 103 patients with a history of lymphoma had anti-tissue transglutaminase antibodies (atTGA) and their class A, G, and M immunoglobulin (IgA, IgG) levels determined. Patients with atTGA positivity underwent enterobiopsy and CD-associated HLA locus testing.

Results

The mean age of patients was 55 ( ± 13.5) years. The predominant lymphoma types included B-type non-Hodgkin’s lymphoma (B-NHL, 66 %), T-type NHL (8 %), and Hodgkin’s lymphoma (26 %). Serological positivity was documented in 3.9 % of cases; one patient had the diagnosis of CD confirmed by enterobiopsy. In 11 patients (10.7 %), IgA levels were decreased to a various extent; of these patients, 10 were shown to have also their IgG levels decreased. The median time from follow-up to blood collection was 58 (32–104) months. The decrease in immunoglobulin levels correlated with a more advanced stage of the tumor (Ann Arbor III–IV) at the time of diagnosis [1.4 (0.9–2.0) g/l versus 2.4 (1.5–3.0) g/l for IgA, p = 0.0001; and 9.4 (7.2–11.5) g/l versus 11.2 (10.3–12.3) g/l for IgG, p = 0.001] and older age [65 (54–72) years versus 55 (44–61) years for IgA, p = 0.04; and 69 (59–74) years versus 53 (43–61) years for IgG, p = 0.0001]. Rituximab therapy in B-NHL patients had no effect on the subsequent incidence of decreased IgA levels.

Conclusion

Reduced IgA and IgG levels represent important factors contributing to the low detection rate of serological screening for CD in patients with a history of lymphoma.

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Literatur
1.
Zurück zum Zitat Mustalahti K, Catassi C, Reunanen A, et al. The prevalence of celiac disease in Europe: results of a centralized, international mass screening project. Ann Med. 2010;42(8):587–95. doi:10.3109/07853890.2010.505931. PubMedCrossRef Mustalahti K, Catassi C, Reunanen A, et al. The prevalence of celiac disease in Europe: results of a centralized, international mass screening project. Ann Med. 2010;42(8):587–95. doi:10.3109/07853890.2010.505931. PubMedCrossRef
2.
Zurück zum Zitat Richey R, Howdle P, Shaw E, Stokes T. Recognition and assessment of coeliac disease in children and adults: summary of NICE guidance. BMJ. 2009;338:b1684. doi:10.1136/bmj.b2351. PubMedCrossRef Richey R, Howdle P, Shaw E, Stokes T. Recognition and assessment of coeliac disease in children and adults: summary of NICE guidance. BMJ. 2009;338:b1684. doi:10.1136/bmj.b2351. PubMedCrossRef
3.
Zurück zum Zitat Reddick BK, Crowell K, Fu B. Clinical inquiries: what blood tests help diagnose celiac disease? J Fam Pract. 2006;55(12):1088, 90, 93. Reddick BK, Crowell K, Fu B. Clinical inquiries: what blood tests help diagnose celiac disease? J Fam Pract. 2006;55(12):1088, 90, 93.
4.
Zurück zum Zitat Haines ML, Anderson RP, Gibson PR. Systematic review: the evidence base for long-term management of coeliac disease. Aliment Pharmacol Ther. 2008;28(9):1042–66. doi:10.1111/j.1365-2036.2008.03820.x. Haines ML, Anderson RP, Gibson PR. Systematic review: the evidence base for long-term management of coeliac disease. Aliment Pharmacol Ther. 2008;28(9):1042–66. doi:10.1111/j.1365-2036.2008.03820.x.
5.
Zurück zum Zitat Logan RF, Rifkind EA, Turner ID, Ferguson A. Mortality in celiac disease. Gastroenterology. 1989;97(2):265–71. PubMed Logan RF, Rifkind EA, Turner ID, Ferguson A. Mortality in celiac disease. Gastroenterology. 1989;97(2):265–71. PubMed
6.
Zurück zum Zitat Mearin ML, Catassi C, Brousse N, et al. European multi-centre study on coeliac disease and non-Hodgkin lymphoma. Eur J Gastroenterol Hepatol. 2006;18(2):187–94. doi:10.1097/00042737-200602000-00012. PubMedCrossRef Mearin ML, Catassi C, Brousse N, et al. European multi-centre study on coeliac disease and non-Hodgkin lymphoma. Eur J Gastroenterol Hepatol. 2006;18(2):187–94. doi:10.1097/00042737-200602000-00012. PubMedCrossRef
7.
Zurück zum Zitat Kumar P. Coeliac disease and lymphoma. Eur J Gastroenterol Hepatol. 2006;18(2):131–2. doi:10.1097/00042737-200602000-00004. PubMedCrossRef Kumar P. Coeliac disease and lymphoma. Eur J Gastroenterol Hepatol. 2006;18(2):131–2. doi:10.1097/00042737-200602000-00004. PubMedCrossRef
8.
Zurück zum Zitat Martin II, Arce CA, Cruz MO, Estella AJ, Martin Mateos MA. Humoral immunity in pediatric patients with acute lymphoblastic leukaemia. Allergol Immunopathol (Madr). 2003;31(6):303–10. doi:10.1157/13055208. Martin II, Arce CA, Cruz MO, Estella AJ, Martin Mateos MA. Humoral immunity in pediatric patients with acute lymphoblastic leukaemia. Allergol Immunopathol (Madr). 2003;31(6):303–10. doi:10.1157/13055208.
9.
Zurück zum Zitat Sabattini E, Bacci F, Sagramoso C, Pileri SA. WHO classification of tumours of haematopoietic and lymphoid tissues in 2008: an overview. Pathologica. 2010;102(3):83–7. PubMed Sabattini E, Bacci F, Sagramoso C, Pileri SA. WHO classification of tumours of haematopoietic and lymphoid tissues in 2008: an overview. Pathologica. 2010;102(3):83–7. PubMed
10.
Zurück zum Zitat Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma. J Clin Oncol. 2007;25(5):579–86. doi:10.1200/JCO.2006.09.2403. PubMedCrossRef Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma. J Clin Oncol. 2007;25(5):579–86. doi:10.1200/JCO.2006.09.2403. PubMedCrossRef
11.
Zurück zum Zitat Rai KR, Sawitsky A, Cronkite EP, Chanana AD, Levy RN, Pasternack BS. Clinical staging of chronic lymphocytic leukemia. Blood. 1975;46(2):219–34. PubMed Rai KR, Sawitsky A, Cronkite EP, Chanana AD, Levy RN, Pasternack BS. Clinical staging of chronic lymphocytic leukemia. Blood. 1975;46(2):219–34. PubMed
12.
Zurück zum Zitat Catassi C, Fabiani E, Corrao G, et al. Risk of non-Hodgkin lymphoma in celiac disease. JAMA. 2002;287(11):1413–9. doi:10.1001/jama.287.11.1413. PubMedCrossRef Catassi C, Fabiani E, Corrao G, et al. Risk of non-Hodgkin lymphoma in celiac disease. JAMA. 2002;287(11):1413–9. doi:10.1001/jama.287.11.1413. PubMedCrossRef
13.
Zurück zum Zitat Carroccio A, Iannitto E, Di PL, et al. Screening for celiac disease in non-Hodgkin’s lymphoma patients: a serum anti-transglutaminase-based approach. Dig Dis Sci. 2003;48(8):1530–6. doi:10.1023/A:1024811707311. PubMedCrossRef Carroccio A, Iannitto E, Di PL, et al. Screening for celiac disease in non-Hodgkin’s lymphoma patients: a serum anti-transglutaminase-based approach. Dig Dis Sci. 2003;48(8):1530–6. doi:10.1023/A:1024811707311. PubMedCrossRef
14.
Zurück zum Zitat Cil T, Altintas A, Isikdogan A, et al. Screening for celiac disease in Hodgkin and non-Hodgkin lymphoma patients. Turk J Gastroenterol. 2009;20(2):87–92. PubMed Cil T, Altintas A, Isikdogan A, et al. Screening for celiac disease in Hodgkin and non-Hodgkin lymphoma patients. Turk J Gastroenterol. 2009;20(2):87–92. PubMed
15.
Zurück zum Zitat Plosker GL, Figgitt DP. Rituximab: a review of its use in non-Hodgkin’s lymphoma and chronic lymphocytic leukaemia. Drugs. 2003;63(8):803–43. doi:10.2165/00003495-200363080-00005. PubMedCrossRef Plosker GL, Figgitt DP. Rituximab: a review of its use in non-Hodgkin’s lymphoma and chronic lymphocytic leukaemia. Drugs. 2003;63(8):803–43. doi:10.2165/00003495-200363080-00005. PubMedCrossRef
16.
Zurück zum Zitat van AS, Holvast A, Telgt DS, et al. Patients with humoral primary immunodeficiency do not develop protective anti-influenza antibody titers after vaccination with trivalent subunit influenza vaccine. Clin Immunol. 2010;136(2):228–35. doi:10.1016/j.clim.2010.03.430. CrossRef van AS, Holvast A, Telgt DS, et al. Patients with humoral primary immunodeficiency do not develop protective anti-influenza antibody titers after vaccination with trivalent subunit influenza vaccine. Clin Immunol. 2010;136(2):228–35. doi:10.1016/j.clim.2010.03.430. CrossRef
17.
Zurück zum Zitat Rousseau B, Loulergue P, Mir O, et al. Immunogenicity and safety of the influenza A H1N1 in 2009 vaccine in cancer patients treated with cytotoxic chemotherapy and/or targeted therapy: the VACANCE study. Ann Oncol. 2011. doi:10.1093/annonc/mdr141. Rousseau B, Loulergue P, Mir O, et al. Immunogenicity and safety of the influenza A H1N1 in 2009 vaccine in cancer patients treated with cytotoxic chemotherapy and/or targeted therapy: the VACANCE study. Ann Oncol. 2011. doi:10.1093/annonc/mdr141.
18.
Zurück zum Zitat Farre C, Domingo-Domenech E, Font R, et al. Celiac disease and lymphoma risk: a multicentric case-control study in Spain. Dig Dis Sci. 2004;49(3):408–12. doi:10.1023/B:DDAS.0000020494.79480.30. PubMedCrossRef Farre C, Domingo-Domenech E, Font R, et al. Celiac disease and lymphoma risk: a multicentric case-control study in Spain. Dig Dis Sci. 2004;49(3):408–12. doi:10.1023/B:DDAS.0000020494.79480.30. PubMedCrossRef
19.
Zurück zum Zitat Karell K, Louka AS, Moodie SJ, et al. HLA types in celiac disease patients not carrying the DQA1*05-DQB1*02 (DQ2) heterodimer: results from the European Genetics Cluster on Celiac Disease. Hum Immunol. 2003;64(4):469–77. doi:10.1016/S0198-8859(03)00027-2. PubMedCrossRef Karell K, Louka AS, Moodie SJ, et al. HLA types in celiac disease patients not carrying the DQA1*05-DQB1*02 (DQ2) heterodimer: results from the European Genetics Cluster on Celiac Disease. Hum Immunol. 2003;64(4):469–77. doi:10.1016/S0198-8859(03)00027-2. PubMedCrossRef
20.
Zurück zum Zitat Ludvigsson JF, Leffler DA, Bai JC, et al. The Oslo definitions for coeliac disease and related terms. Gut. 2013;62(1):43–52. doi:10.1136/gutjnl-2011-301346. Ludvigsson JF, Leffler DA, Bai JC, et al. The Oslo definitions for coeliac disease and related terms. Gut. 2013;62(1):43–52. doi:10.1136/gutjnl-2011-301346.
21.
Zurück zum Zitat Katz KD, Rashtak S, Lahr BD, et al. Screening for celiac disease in a North American population: sequential serology and gastrointestinal symptoms. Am J Gastroenterol. 2011;106(7):1333–9. doi:10.1038/ajg.2011.21. PubMedCrossRef Katz KD, Rashtak S, Lahr BD, et al. Screening for celiac disease in a North American population: sequential serology and gastrointestinal symptoms. Am J Gastroenterol. 2011;106(7):1333–9. doi:10.1038/ajg.2011.21. PubMedCrossRef
22.
Zurück zum Zitat Biagi F, Trotta L, Alfano C, et al. Prevalence and natural history of potential celiac disease in adult patients. Scand J Gastroenterol. 2013;48(5):537–42. doi:10.3109/00365521.2013.777470. PubMedCrossRef Biagi F, Trotta L, Alfano C, et al. Prevalence and natural history of potential celiac disease in adult patients. Scand J Gastroenterol. 2013;48(5):537–42. doi:10.3109/00365521.2013.777470. PubMedCrossRef
23.
Zurück zum Zitat Vanickova Z, Chlumecky V, Sokol D, et al. The serologic screening for celiac disease in the general population (blood donors) and in some high-risk groups of adults (patients with autoimmune diseases, osteoporosis and infertility) in the Czech Republic. Folia Microbiol (Praha). 2002;47(6):753–8. doi:10.1007/BF02818684. CrossRef Vanickova Z, Chlumecky V, Sokol D, et al. The serologic screening for celiac disease in the general population (blood donors) and in some high-risk groups of adults (patients with autoimmune diseases, osteoporosis and infertility) in the Czech Republic. Folia Microbiol (Praha). 2002;47(6):753–8. doi:10.1007/BF02818684. CrossRef
Metadaten
Titel
Diagnosing celiac disease in patients with a history of lymphoma: factors that matter
verfasst von
Karel Balihar
Jana Kozeluhova
Vaclav Hejda
Michal Krcma
Daniel Lysak
Jitka Gorcikova
Ondrej Hes
Martin Matejovic
Publikationsdatum
01.11.2013
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 21-22/2013
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-013-0437-9