Taken into consideration that serum anti-Ro/SSA [57], earlier disease onset [58], lower HGB values [59], and heightened serum BAFF levels [4] have all been previously associated with lymphoma development among SS patients, it seems that alterations of the IGF1/IGF1R axis could be significant contributors of severe inflammation and malignant transformation in the setting of SS. This evidence concerns the gene CALR and lymphoma.