Lymphoma risk was studied in different subsets of pSS.
Cryoglobulinemia, low C4, anti-SSB/La antibodies and leukopenia were significantly associated with lymphoma in pSS.
Presence of ≤1 biomarker provided a high negative predictive value for lymphoma.
Patients with salivary swelling and with positive biomarkers may be at higher risk for lymphoma.