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Risk of Non-Hodgkin Lymphoma in Celiac Disease
Carlo Catassi, MD;
Elisabetta Fabiani, MD;
Giovanni Corrao, PhD;
Maria Barbato, MD;
Amalia De Renzo, MD;
Angelo M. Carella, MD;
Armando Gabrielli, MD;
Pietro Leoni, MD;
Antonio Carroccio, MD;
Mariella Baldassarre, MD;
Paolo Bertolani, MD;
Paola Caramaschi, MD;
Michele Sozzi, MD;
Graziella Guariso, MD;
Umberto Volta, MD;
Gino R. Corazza, MD;
for the Italian Working Group on Coeliac Disease and Non–Hodgkin's-Lymphoma
JAMA. 2002;287:1413-1419.
Context Celiac disease is one of the most common lifelong disorders. Non-Hodgkin lymphoma is a possible complication of celiac disease and may lead to a large portion of lymphoma cases.
Objective To quantify the risk for developing non-Hodgkin lymphoma of any primary site associated with celiac disease.
Design and Setting Multicenter, case-control study conducted between January 1996 and December 1999 throughout Italy.
Patients Cases were older than 20 years (median, 57; range, 20-92 years) with non-Hodgkin lymphoma of any primary site and histological type and were recruited at the time of the diagnosis. Controls were healthy adults (2739 men and 2981 women) from the general population.
Main Outcome Measure Positive test result for class A serum antiendomysial antibody.
Results Celiac disease was diagnosed in 6 (0.92%) of 653 patients with lymphoma. Of the 6 cases, 3 were of B-cell and 3 were of T-cell origin. Four of 6 cases had lymphoma primarily located in the gut. In the control group, 24 (0.42%) had celiac disease. The odds ratio (adjusted for age and sex) for non-Hodgkin lymphoma of any primary site associated with celiac disease was 3.1 (95% confidence interval [CI], 1.3-7.6), 16.9 (95% CI, 7.4-38.7) for gut lymphoma, and 19.2 (95% CI, 7.9-46.6) for T-cell lymphoma, respectively. The risk for non-Hodgkin lymphoma for the overall population, which was adjusted for age and sex, was 0.63% (95% CI, - 0.12% to 1.37%).
Conclusion Celiac disease is associated with an increased risk for non-Hodgkin lymphoma, especially of T-cell type and primarily localized in the gut. However, the association does not represent a great enough risk to justify early mass screening for celiac disease.
Author Affiliations: Center for Celiac Research, University of Maryland, Baltimore (Dr Catassi); University Department of Pediatrics (Drs Catassi and Fabiani), Internal Medicine (Dr Gabrielli), Hematology (Dr Leoni), Ancona; Department of Statistics, University of Milano-Bicocca (Dr Corrao); Department of Pediatric Gastroenterology, University La Sapienza, Rome (Dr Barbato); Department of Clinical Hematology, University Federico II, Naples (Dr De Renzo); Department of Hematology, Casa Sollievo della Sofferenza Hospital, S. Giovanni Rotondo (Dr Carella); Internal Medicine Division, University Hospital of Palermo (Dr Carroccio); University Department of Pediatrics, Bari (Dr Baldassarre); Department of Pediatrics, Azienda Policlinico, Modena (Dr Bertolani); University Department of Clinical Medicine, Verona (Dr Caramaschi); Division of Gastroenterology and Digestive Endoscopy, National Cancer Center, Aviano (Dr Sozzi); University Department of Pediatrics, Padua (Dr Guariso); Department of Internal Medicine, Bologna (Dr Volta); and University Department of Gastroenterology, Pavia, Italy (Dr Corazza).
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