The relationship between cancer and medication exposures in systemic lupus erythaematosus: a case–cohort study
Identifieur interne : 001959 ( Main/Exploration ); précédent : 001958; suivant : 001960The relationship between cancer and medication exposures in systemic lupus erythaematosus: a case–cohort study
Auteurs : S. Bernatsky [Canada] ; L. Joseph [Canada] ; J-F Boivin [Canada] ; C. Gordon [Canada] ; M. Urowitz [États-Unis] ; D. Gladman [États-Unis] ; P R Fortin [États-Unis] ; E. Ginzler [Corée du Sud] ; S-C Bae [Canada] ; S. Barr [Royaume-Uni] ; S. Edworthy [Royaume-Uni] ; D. Isenberg [États-Unis] ; A. Rahman [États-Unis] ; M. Petri [États-Unis] ; G S Alarc N [États-Unis] ; C. Aranow [États-Unis] ; M-A Dooley [Canada] ; R. Rajan [Canada] ; J-L Sénécal [Canada] ; M. Zummer [États-Unis] ; S. Manzi [États-Unis] ; R. Ramsey-Goldman [Canada, Royaume-Uni, États-Unis, Corée du Sud] ; A E Clarke [Canada]Source :
- Annals of the Rheumatic Diseases [ 0003-4967 ] ; 2008-01.
English descriptors
- Teeft :
- America cohort entry, America sjogren syndrome, American college, Arthritis, Arthritis foundation, Aspirin, Autoimmune diseases, Azathioprine, Bladder cancers, Breast cancer, Calendar year, Cancer, Cancer cases, Cancer incidence, Cancer occurrence, Cancer risk, Carcinogenic risks, Categorical variables, Centre, Cervical, Cervical dysplasia, Chapel hill, Chemotherapy effects, Clinical characteristics, Clinical epidemiology, Clinical factors, Clinical immunology, Cohort, Cohort entry, Cohort studies, Cohort study, Confirmatory tests, Cumulative disease activity, Cumulative exposure, Cumulative exposures, Cyclophosphamide, Cyclophosphamide azathioprine methotrexate agents, Cyclophosphamide exposure, Cyclophosphamide exposures, Damage index, Damage item, Damage scores, Data collection, Disease activity, Drug exposures, Erythematosus, Exploratory analyses, Exposure categories, Glucocorticoids nsaids aspirin tobacco, Haematological, Haematological cancer, Haematological cancers, Haematological malignancies, Hazard ratio, Iarc monographs, Immunosuppressive, Immunosuppressive agents, Immunosuppressive drug, Immunosuppressive drug exposure, Immunosuppressive drug exposures, Immunosuppressive drugs, Immunosuppressive therapy, Immunosuppressive treatment, Index time, International agency, International cohort study, Intravenous, Intravenous cyclophosphamide, Invasive cancers, Investigator award, Johns hopkins university, Lung cancer, Lung cancers, Lupus, Lupus cohort, Lymphoma, Lymphoma risk, Malignancy, Malignancy risk, Mcgill university health centre, Medication, Medication exposures, Methotrexate, Nsaid, Organ damage, Other medication, Overall cancer risk, Parenteral exposures, Potential confounder, Power limitations, Primary analyses, Primary exposure, Report table, Research institute, Rheum, Rheumatic diseases, Rheumatoid arthritis, Rheumatol, Rheumatology, Rheumatology damage index, Second cancers, Separate analyses, Sicca symptoms, Sjogren, Sjogren syndrome, Study entry, Syndrome, Systematic overview, Systemic, Systemic lupus, Systemic lupus erythaematosus, Systemic lupus erythematosus, Time axis, Tobacco exposure, Tumour registries, White damage1 residence.
Abstract
Objective: To examine if, in systemic lupus erythaematosus (SLE), exposure to immunosuppressive therapy (cyclophosphamide, azathioprine, methotrexate) increases cancer risk. Methods: A case–cohort study was performed within a multi-site international SLE cohort; subjects were linked to regional tumour registries to determine cancer cases occurring after entry into the cohort. We calculated the hazard ratio (HR) for cancer after exposure to an immunosuppressive drug, in models that controlled for other medications (anti-malarial drugs, systemic glucocorticoids, non-steroidal anti-inflammatory drugs (NSAIDs), aspirin), smoking, age, sex, race/ethnicity, geographic location, calendar year, SLE duration, and lupus damage scores. In the primary analyses, exposures were treated categorically (ever/never) and as time-dependent. Results: Results are presented from 246 cancer cases and 538 controls without cancer. The adjusted HR for overall cancer risk after any immunosuppressive drug was 0.82 (95% CI 0.50–1.36). Age ⩾65, and the presence of non-malignancy damage were associated with overall cancer risk. For lung cancer (n = 35 cases), smoking was also a prominent risk factor. When looking at haematological cancers specifically (n = 46 cases), there was a suggestion of an increased risk after immunosuppressive drug exposures, particularly when these were lagged by a period of 5 years (adjusted HR 2.29, 95% CI 1.02–5.15). Conclusions: In our SLE sample, age ⩾65, damage, and tobacco exposure were associated with cancer risk. Though immunosuppressive therapy may not be the principal driving factor for overall cancer risk, it may contribute to an increased risk of haematological malignancies. Future studies are in progress to evaluate independent influence of medication exposures and disease activity on risk of malignancy.
Url:
DOI: 10.1136/ard.2006.069039
Affiliations:
- Canada, Corée du Sud, Royaume-Uni, États-Unis
- Alabama, Alberta, Angleterre, Caroline du Nord, Grand Londres, Illinois, Maryland, Midlands de l'Ouest, Pennsylvanie, Québec, Région capitale de Séoul, État de New York
- Birmingham, Calgary, Chapel Hill (Caroline du Nord), Londres, Montréal, New York, Pittsburgh, Séoul
- University College de Londres, Université Columbia, Université McGill, Université de Birmingham, Université de Calgary, Université de Caroline du Nord à Chapel Hill, Université de Pittsburgh
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Edworthy</name><affiliation wicri:level="4"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Rheumatology Research - Department of Medicine, University College London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">University College de Londres</orgName></affiliation></author><author><name sortKey="Isenberg, D" sort="Isenberg, D" uniqKey="Isenberg D" first="D" last="Isenberg">D. Isenberg</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland</wicri:regionArea><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Rahman, A" sort="Rahman, A" uniqKey="Rahman A" first="A" last="Rahman">A. 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Petri</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama, Birmingham, Alabama</wicri:regionArea><placeName><region type="state">Alabama</region></placeName></affiliation></author><author><name sortKey="Alarc N, G S" sort="Alarc N, G S" uniqKey="Alarc N G" first="G S" last="Alarc N">G S Alarc N</name><affiliation wicri:level="4"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, Columbia University, New York</wicri:regionArea><placeName><region type="state">État de New York</region><settlement type="city">New York</settlement></placeName><orgName type="university">Université Columbia</orgName></affiliation></author><author><name sortKey="Aranow, C" sort="Aranow, C" uniqKey="Aranow C" first="C" last="Aranow">C. Aranow</name><affiliation wicri:level="4"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill, North Carolina</wicri:regionArea><placeName><region type="state">Caroline du Nord</region><settlement type="city">Chapel Hill (Caroline du Nord)</settlement></placeName><orgName type="university">Université de Caroline du Nord à Chapel Hill</orgName></affiliation></author><author><name sortKey="Dooley, M A" sort="Dooley, M A" uniqKey="Dooley M" first="M-A" last="Dooley">M-A Dooley</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Oncology, McGill University Health Centre, Montreal, Quebec</wicri:regionArea><wicri:noRegion>Quebec</wicri:noRegion></affiliation></author><author><name sortKey="Rajan, R" sort="Rajan, R" uniqKey="Rajan R" first="R" last="Rajan">R. Rajan</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>Division of Rheumatology, Centre Hospitalier de l’Universite de Montreal, Department of Medicine, University of Montreal School of Medicine, Montreal, Quebec</wicri:regionArea><wicri:noRegion>Quebec</wicri:noRegion></affiliation></author><author><name sortKey="Senecal, J L" sort="Senecal, J L" uniqKey="Senecal J" first="J-L" last="Sénécal">J-L Sénécal</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Rheumatology, Maisonneuve-Rosemont Hospital, Montreal, Quebec</wicri:regionArea><wicri:noRegion>Quebec</wicri:noRegion></affiliation></author><author><name sortKey="Zummer, M" sort="Zummer, M" uniqKey="Zummer M" first="M" last="Zummer">M. Zummer</name><affiliation wicri:level="4"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania</wicri:regionArea><placeName><region type="state">Pennsylvanie</region><settlement type="city">Pittsburgh</settlement></placeName><orgName type="university">Université de Pittsburgh</orgName></affiliation></author><author><name sortKey="Manzi, S" sort="Manzi, S" uniqKey="Manzi S" first="S" last="Manzi">S. Manzi</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois</wicri:regionArea><placeName><region type="state">Illinois</region></placeName></affiliation></author><author><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>1 Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec</wicri:regionArea><wicri:noRegion>Quebec</wicri:noRegion></affiliation><affiliation wicri:level="4"><country xml:lang="fr">Canada</country><wicri:regionArea>2 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec</wicri:regionArea><orgName type="university">Université McGill</orgName><placeName><settlement type="city">Montréal</settlement><region type="state">Québec</region></placeName></affiliation><affiliation wicri:level="4"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>3 Department of Rheumatology, University of Birmingham</wicri:regionArea><placeName><settlement type="city">Birmingham</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Midlands de l'Ouest</region></placeName><orgName type="university">Université de Birmingham</orgName></affiliation><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>4 Division of Health Care & Outcomes Research, Toronto Western Research Institute, Toronto, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>5 Division of Rheumatology, Department of Medicine, SUNY Health Science Center at Brooklyn, New York</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation><affiliation wicri:level="3"><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>6 Department of Internal Medicine, Division of Rheumatology, Hanyang University College of Medicine and the Hospital of Rheumatic Diseases, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation><affiliation wicri:level="4"><country xml:lang="fr">Canada</country><wicri:regionArea>7 Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta</wicri:regionArea><orgName type="university">Université de Calgary</orgName><placeName><settlement type="city">Calgary</settlement><region type="state">Alberta</region></placeName></affiliation><affiliation wicri:level="4"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>8 Centre for Rheumatology Research - Department of Medicine, University College London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">University College de Londres</orgName></affiliation><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>9 Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland</wicri:regionArea><placeName><region type="state">Maryland</region></placeName></affiliation><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>10 Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama, Birmingham, Alabama</wicri:regionArea><placeName><region type="state">Alabama</region></placeName></affiliation><affiliation wicri:level="4"><country xml:lang="fr">États-Unis</country><wicri:regionArea>11 Department of Medicine, Columbia University, New York</wicri:regionArea><placeName><region type="state">État de New York</region><settlement type="city">New York</settlement></placeName><orgName type="university">Université Columbia</orgName></affiliation><affiliation wicri:level="4"><country xml:lang="fr">États-Unis</country><wicri:regionArea>12 Department of Medicine, Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill, North Carolina</wicri:regionArea><placeName><region type="state">Caroline du Nord</region><settlement type="city">Chapel Hill (Caroline du Nord)</settlement></placeName><orgName type="university">Université de Caroline du Nord à Chapel Hill</orgName></affiliation><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>13 Department of Oncology, McGill University Health Centre, Montreal, Quebec</wicri:regionArea><wicri:noRegion>Quebec</wicri:noRegion></affiliation><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>14 Division of Rheumatology, Centre Hospitalier de l’Universite de Montreal, Department of Medicine, University of Montreal School of Medicine, Montreal, Quebec</wicri:regionArea><wicri:noRegion>Quebec</wicri:noRegion></affiliation><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>15 Department of Rheumatology, Maisonneuve-Rosemont Hospital, Montreal, Quebec</wicri:regionArea><wicri:noRegion>Quebec</wicri:noRegion></affiliation><affiliation wicri:level="4"><country xml:lang="fr">États-Unis</country><wicri:regionArea>16 Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania</wicri:regionArea><placeName><region type="state">Pennsylvanie</region><settlement type="city">Pittsburgh</settlement></placeName><orgName type="university">Université de Pittsburgh</orgName></affiliation><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>17 Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois</wicri:regionArea><placeName><region type="state">Illinois</region></placeName></affiliation></author><author><name sortKey="Clarke, A E" sort="Clarke, A E" uniqKey="Clarke A" first="A E" last="Clarke">A E Clarke</name><affiliation wicri:level="4"><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec</wicri:regionArea><orgName type="university">Université McGill</orgName><placeName><settlement type="city">Montréal</settlement><region type="state">Québec</region></placeName></affiliation></author></analytic><monogr></monogr><series><title level="j">Annals of the Rheumatic Diseases</title><title level="j" type="abbrev">Ann Rheum Dis</title><idno type="ISSN">0003-4967</idno><idno type="eISSN">1468-2060</idno><imprint><publisher>BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><date type="published" when="2008-01">2008-01</date><biblScope unit="volume">67</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="74">74</biblScope></imprint><idno type="ISSN">0003-4967</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0003-4967</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>America cohort entry</term><term>America sjogren syndrome</term><term>American college</term><term>Arthritis</term><term>Arthritis foundation</term><term>Aspirin</term><term>Autoimmune diseases</term><term>Azathioprine</term><term>Bladder cancers</term><term>Breast cancer</term><term>Calendar year</term><term>Cancer</term><term>Cancer cases</term><term>Cancer incidence</term><term>Cancer occurrence</term><term>Cancer risk</term><term>Carcinogenic risks</term><term>Categorical variables</term><term>Centre</term><term>Cervical</term><term>Cervical dysplasia</term><term>Chapel hill</term><term>Chemotherapy effects</term><term>Clinical characteristics</term><term>Clinical epidemiology</term><term>Clinical factors</term><term>Clinical immunology</term><term>Cohort</term><term>Cohort entry</term><term>Cohort studies</term><term>Cohort study</term><term>Confirmatory tests</term><term>Cumulative disease activity</term><term>Cumulative exposure</term><term>Cumulative exposures</term><term>Cyclophosphamide</term><term>Cyclophosphamide azathioprine methotrexate agents</term><term>Cyclophosphamide exposure</term><term>Cyclophosphamide exposures</term><term>Damage index</term><term>Damage item</term><term>Damage scores</term><term>Data collection</term><term>Disease activity</term><term>Drug exposures</term><term>Erythematosus</term><term>Exploratory analyses</term><term>Exposure categories</term><term>Glucocorticoids nsaids aspirin tobacco</term><term>Haematological</term><term>Haematological cancer</term><term>Haematological cancers</term><term>Haematological malignancies</term><term>Hazard ratio</term><term>Iarc monographs</term><term>Immunosuppressive</term><term>Immunosuppressive agents</term><term>Immunosuppressive drug</term><term>Immunosuppressive drug exposure</term><term>Immunosuppressive drug exposures</term><term>Immunosuppressive drugs</term><term>Immunosuppressive therapy</term><term>Immunosuppressive treatment</term><term>Index time</term><term>International agency</term><term>International cohort study</term><term>Intravenous</term><term>Intravenous cyclophosphamide</term><term>Invasive cancers</term><term>Investigator award</term><term>Johns hopkins university</term><term>Lung cancer</term><term>Lung cancers</term><term>Lupus</term><term>Lupus cohort</term><term>Lymphoma</term><term>Lymphoma risk</term><term>Malignancy</term><term>Malignancy risk</term><term>Mcgill university health centre</term><term>Medication</term><term>Medication exposures</term><term>Methotrexate</term><term>Nsaid</term><term>Organ damage</term><term>Other medication</term><term>Overall cancer risk</term><term>Parenteral exposures</term><term>Potential confounder</term><term>Power limitations</term><term>Primary analyses</term><term>Primary exposure</term><term>Report table</term><term>Research institute</term><term>Rheum</term><term>Rheumatic diseases</term><term>Rheumatoid arthritis</term><term>Rheumatol</term><term>Rheumatology</term><term>Rheumatology damage index</term><term>Second cancers</term><term>Separate analyses</term><term>Sicca symptoms</term><term>Sjogren</term><term>Sjogren syndrome</term><term>Study entry</term><term>Syndrome</term><term>Systematic overview</term><term>Systemic</term><term>Systemic lupus</term><term>Systemic lupus erythaematosus</term><term>Systemic lupus erythematosus</term><term>Time axis</term><term>Tobacco exposure</term><term>Tumour registries</term><term>White damage1 residence</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Objective: To examine if, in systemic lupus erythaematosus (SLE), exposure to immunosuppressive therapy (cyclophosphamide, azathioprine, methotrexate) increases cancer risk. Methods: A case–cohort study was performed within a multi-site international SLE cohort; subjects were linked to regional tumour registries to determine cancer cases occurring after entry into the cohort. We calculated the hazard ratio (HR) for cancer after exposure to an immunosuppressive drug, in models that controlled for other medications (anti-malarial drugs, systemic glucocorticoids, non-steroidal anti-inflammatory drugs (NSAIDs), aspirin), smoking, age, sex, race/ethnicity, geographic location, calendar year, SLE duration, and lupus damage scores. In the primary analyses, exposures were treated categorically (ever/never) and as time-dependent. Results: Results are presented from 246 cancer cases and 538 controls without cancer. The adjusted HR for overall cancer risk after any immunosuppressive drug was 0.82 (95% CI 0.50–1.36). Age ⩾65, and the presence of non-malignancy damage were associated with overall cancer risk. For lung cancer (n = 35 cases), smoking was also a prominent risk factor. When looking at haematological cancers specifically (n = 46 cases), there was a suggestion of an increased risk after immunosuppressive drug exposures, particularly when these were lagged by a period of 5 years (adjusted HR 2.29, 95% CI 1.02–5.15). Conclusions: In our SLE sample, age ⩾65, damage, and tobacco exposure were associated with cancer risk. Though immunosuppressive therapy may not be the principal driving factor for overall cancer risk, it may contribute to an increased risk of haematological malignancies. Future studies are in progress to evaluate independent influence of medication exposures and disease activity on risk of malignancy.</div></front></TEI><affiliations><list><country><li>Canada</li><li>Corée du Sud</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Alabama</li><li>Alberta</li><li>Angleterre</li><li>Caroline du Nord</li><li>Grand Londres</li><li>Illinois</li><li>Maryland</li><li>Midlands de l'Ouest</li><li>Pennsylvanie</li><li>Québec</li><li>Région capitale de Séoul</li><li>État de New York</li></region><settlement><li>Birmingham</li><li>Calgary</li><li>Chapel Hill (Caroline du Nord)</li><li>Londres</li><li>Montréal</li><li>New York</li><li>Pittsburgh</li><li>Séoul</li></settlement><orgName><li>University College de Londres</li><li>Université Columbia</li><li>Université McGill</li><li>Université de Birmingham</li><li>Université de Calgary</li><li>Université de Caroline du Nord à Chapel Hill</li><li>Université de Pittsburgh</li></orgName></list><tree><country name="Canada"><noRegion><name sortKey="Bernatsky, S" sort="Bernatsky, S" uniqKey="Bernatsky S" first="S" last="Bernatsky">S. Bernatsky</name></noRegion><name sortKey="Bae, S C" sort="Bae, S C" uniqKey="Bae S" first="S-C" last="Bae">S-C Bae</name><name sortKey="Boivin, J F" sort="Boivin, J F" uniqKey="Boivin J" first="J-F" last="Boivin">J-F Boivin</name><name sortKey="Clarke, A E" sort="Clarke, A E" uniqKey="Clarke A" first="A E" last="Clarke">A E Clarke</name><name sortKey="Dooley, M A" sort="Dooley, M A" uniqKey="Dooley M" first="M-A" last="Dooley">M-A Dooley</name><name sortKey="Gordon, C" sort="Gordon, C" uniqKey="Gordon C" first="C" last="Gordon">C. Gordon</name><name sortKey="Joseph, L" sort="Joseph, L" uniqKey="Joseph L" first="L" last="Joseph">L. Joseph</name><name sortKey="Rajan, R" sort="Rajan, R" uniqKey="Rajan R" first="R" last="Rajan">R. Rajan</name><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name><name sortKey="Senecal, J L" sort="Senecal, J L" uniqKey="Senecal J" first="J-L" last="Sénécal">J-L Sénécal</name></country><country name="États-Unis"><region name="État de New York"><name sortKey="Urowitz, M" sort="Urowitz, M" uniqKey="Urowitz M" first="M" last="Urowitz">M. Urowitz</name></region><name sortKey="Alarc N, G S" sort="Alarc N, G S" uniqKey="Alarc N G" first="G S" last="Alarc N">G S Alarc N</name><name sortKey="Aranow, C" sort="Aranow, C" uniqKey="Aranow C" first="C" last="Aranow">C. Aranow</name><name sortKey="Fortin, P R" sort="Fortin, P R" uniqKey="Fortin P" first="P R" last="Fortin">P R Fortin</name><name sortKey="Gladman, D" sort="Gladman, D" uniqKey="Gladman D" first="D" last="Gladman">D. Gladman</name><name sortKey="Isenberg, D" sort="Isenberg, D" uniqKey="Isenberg D" first="D" last="Isenberg">D. Isenberg</name><name sortKey="Manzi, S" sort="Manzi, S" uniqKey="Manzi S" first="S" last="Manzi">S. Manzi</name><name sortKey="Petri, M" sort="Petri, M" uniqKey="Petri M" first="M" last="Petri">M. Petri</name><name sortKey="Rahman, A" sort="Rahman, A" uniqKey="Rahman A" first="A" last="Rahman">A. Rahman</name><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name><name sortKey="Zummer, M" sort="Zummer, M" uniqKey="Zummer M" first="M" last="Zummer">M. Zummer</name></country><country name="Corée du Sud"><region name="Région capitale de Séoul"><name sortKey="Ginzler, E" sort="Ginzler, E" uniqKey="Ginzler E" first="E" last="Ginzler">E. Ginzler</name></region><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Barr, S" sort="Barr, S" uniqKey="Barr S" first="S" last="Barr">S. Barr</name></region><name sortKey="Edworthy, S" sort="Edworthy, S" uniqKey="Edworthy S" first="S" last="Edworthy">S. Edworthy</name><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name><name sortKey="Ramsey Goldman, R" sort="Ramsey Goldman, R" uniqKey="Ramsey Goldman R" first="R" last="Ramsey-Goldman">R. Ramsey-Goldman</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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