Key messages
- L’associazione tra psoriasi cronica e neoplasie ematologiche rimane controversa.
- L’aumentato rischio di neoplasie ematologiche, in particolare di linfoma cutaneo a cellule T, nei pazienti con psoriasi potrebbe essere correlato all’esposizione sistemica cronica alle terapie immunosoppressive e all’attivazione immunologica protratta, in particolare nella cute.
Abstract
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.