Case Report: Lymphoma Arising in an Ileal Pouch Anal Anastomosis After Immunomodulatory Therapy for Inflammatory Bowel Disease
published online 21 July 2006.
Refers to article:
Exploring Utilities and Outcomes With Infliximab Therapy
John M. Inadomi, Jonathan Terdiman
Clinical Gastroenterology and Hepatology
August 2006 (Vol. 4, Issue 8, Pages 976-978) Full Text |
Full-Text PDF (65 KB)
The risk of lymphoma in inflammatory bowel disease (IBD) has raised concerns regarding the lymphogenic potential of immunomodulatory therapy. The link between immunosuppressive therapy and lymphoma risk is well established in patients with solid organ transplantations. In this population, it is postulated that lymphocytes infected with the Epstein-Barr virus (EBV) proliferate unchecked due to impaired cell-mediated immunity. A similar phenomenon may occur in IBD patients treated with multiple immunomodulators and biological agents. In this report, we describe a case of EBV-positive non-Hodgkin’s lymphoma arising in the ileal pouch of a patient with ulcerative colitis. This patient was maintained on prednisone (>20 mg/day) for 8 months, cyclosporine for 7 months, and 6-mercaptopurine for nearly 2 years prior to a single infusion of infliximab (5 mg/kg). The cumulative effects of more than three agents, simultaneously and/or sequentially, may simulate posttransplantation immunosuppression and pose a significant threat of malignancy. Such patients may warrant more aggressive diagnostic surveillance and evaluation.
⁎Division of Gastroenterology, Mount Sinai School of Medicine, New York
‡Division of Hematology-Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
§Division of Pathology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
∥Jill Roberts IBD Center, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
Address requests for reprints to: Lauren K. Schwartz, Jill Roberts IBD Center, Weill Medical College of Cornell University, New York Presbyterian Hospital, 1315 York Avenue, Mezzanine Level, New York, New York 10021.
Dr Scherl has received grant research support from Abbott, Centocor, Elan, Prometheus, and Salix; she has served as a Consultant and on the Advisory Board or Speaker’s Bureau for Abbott, AstraZeneca, Axcan, Centocor, Crohn’s & Colitis Foundation of America (CCFA), Proctor & Gamble, Prometheus Laboratories, Questcor Pharmaceuticals, Salix, Shire, Solvay, and TAP Pharmaceuticals; has received honorarium from Abbott, AstraZeneca, Axcan, Centocor, Proctor & Gamble, Prometheus Laboratories, Salix Pharmaceuticals, Solvay, and TAP Pharmaceuticals; and has received other financial or material support from Centocor-Research, Salix-Research, Abbott-Research, Prometheus-Research, and CCFA-Research.
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