Hepatosplenic T-cell lymphoma in patients receiving TNF-α inhibitor therapy

Expanding the groups at risk

Deepak Parakkal, Humberto Sifuentes, Rumi Semer, Eli Daniel Ehrenpreis

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

BACKGROUND: Hepatosplenic T-cell lymphoma (HSTCL) is a rare, lethal disease generally seen in young male patients with inflammatory bowel disease. The study of biologic and immunomodulator naive patients in Crohn's disease (SONIC), advocates combining infliximab with an immunomodulator in moderate-to-severe Crohn's disease. Unfortunately, combined immunosuppression increases risk for HSTCL. We herein review all cases of HSTCL reported to the Food and Drug Administration (FDA) in patients receiving TNF-α inhibitors. METHODS: Individual reports from the FDA Adverse Event Reporting System database for lymphomas from the biological agents-infliximab, adalimumab, certolizumab, natalizumab, and etanercept were downloaded and analyzed with Microsoft Access. Full reports for all identified HSTCL cases were obtained from the FDA. RESULTS: Twenty-five cases of HSTCL were identified. Twenty-two (88%) patients had inflammatory bowel disease and three had rheumatoid arthritis. Four cases (16%) were in women and four patients were above 65 years of age. Twenty-four cases (96%) also received an immunomodulator (azathioprine, 6-mercaptopurine, or methotrexate). Two patients received adalimumab alone. CONCLUSION: HSTCL is no longer restricted to the previously identified risk group of young male patients, but can also occur in patients with rheumatoid arthritis, females and older adults receiving TNF-α inhibitors and immunomodulators. Improved disease outcomes using combination therapy should be tempered by the risk of developing HSTCL.

Original languageEnglish (US)
Pages (from-to)1150-1156
Number of pages7
JournalEuropean Journal of Gastroenterology and Hepatology
Volume23
Issue number12
DOIs
StatePublished - Nov 1 2011

Fingerprint

T-Cell Lymphoma
Group Psychotherapy
Immunologic Factors
United States Food and Drug Administration
Inflammatory Bowel Diseases
Crohn Disease
Rheumatoid Arthritis
6-Mercaptopurine
Azathioprine
Biological Factors
Rare Diseases
Methotrexate
Immunosuppression
Lymphoma
Databases

Keywords

  • cancer
  • colitis
  • hepatosplenic T-cell lymphoma
  • inflammatory bowel disease
  • lymphoma
  • methotrexate
  • older adults
  • rheumatoid arthritis
  • TNF-α inhibitors
  • women

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Hepatosplenic T-cell lymphoma in patients receiving TNF-α inhibitor therapy : Expanding the groups at risk. / Parakkal, Deepak; Sifuentes, Humberto; Semer, Rumi; Ehrenpreis, Eli Daniel.

In: European Journal of Gastroenterology and Hepatology, Vol. 23, No. 12, 01.11.2011, p. 1150-1156.

Research output: Contribution to journalArticle

@article{cb5c9efba4cf4da29cb21fbd2df99294,
title = "Hepatosplenic T-cell lymphoma in patients receiving TNF-α inhibitor therapy: Expanding the groups at risk",
abstract = "BACKGROUND: Hepatosplenic T-cell lymphoma (HSTCL) is a rare, lethal disease generally seen in young male patients with inflammatory bowel disease. The study of biologic and immunomodulator naive patients in Crohn's disease (SONIC), advocates combining infliximab with an immunomodulator in moderate-to-severe Crohn's disease. Unfortunately, combined immunosuppression increases risk for HSTCL. We herein review all cases of HSTCL reported to the Food and Drug Administration (FDA) in patients receiving TNF-α inhibitors. METHODS: Individual reports from the FDA Adverse Event Reporting System database for lymphomas from the biological agents-infliximab, adalimumab, certolizumab, natalizumab, and etanercept were downloaded and analyzed with Microsoft Access. Full reports for all identified HSTCL cases were obtained from the FDA. RESULTS: Twenty-five cases of HSTCL were identified. Twenty-two (88{\%}) patients had inflammatory bowel disease and three had rheumatoid arthritis. Four cases (16{\%}) were in women and four patients were above 65 years of age. Twenty-four cases (96{\%}) also received an immunomodulator (azathioprine, 6-mercaptopurine, or methotrexate). Two patients received adalimumab alone. CONCLUSION: HSTCL is no longer restricted to the previously identified risk group of young male patients, but can also occur in patients with rheumatoid arthritis, females and older adults receiving TNF-α inhibitors and immunomodulators. Improved disease outcomes using combination therapy should be tempered by the risk of developing HSTCL.",
keywords = "cancer, colitis, hepatosplenic T-cell lymphoma, inflammatory bowel disease, lymphoma, methotrexate, older adults, rheumatoid arthritis, TNF-α inhibitors, women",
author = "Deepak Parakkal and Humberto Sifuentes and Rumi Semer and Ehrenpreis, {Eli Daniel}",
year = "2011",
month = "11",
day = "1",
doi = "10.1097/MEG.0b013e32834bb90a",
language = "English (US)",
volume = "23",
pages = "1150--1156",
journal = "European Journal of Gastroenterology and Hepatology",
issn = "0954-691X",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

TY - JOUR

T1 - Hepatosplenic T-cell lymphoma in patients receiving TNF-α inhibitor therapy

T2 - Expanding the groups at risk

AU - Parakkal, Deepak

AU - Sifuentes, Humberto

AU - Semer, Rumi

AU - Ehrenpreis, Eli Daniel

PY - 2011/11/1

Y1 - 2011/11/1

N2 - BACKGROUND: Hepatosplenic T-cell lymphoma (HSTCL) is a rare, lethal disease generally seen in young male patients with inflammatory bowel disease. The study of biologic and immunomodulator naive patients in Crohn's disease (SONIC), advocates combining infliximab with an immunomodulator in moderate-to-severe Crohn's disease. Unfortunately, combined immunosuppression increases risk for HSTCL. We herein review all cases of HSTCL reported to the Food and Drug Administration (FDA) in patients receiving TNF-α inhibitors. METHODS: Individual reports from the FDA Adverse Event Reporting System database for lymphomas from the biological agents-infliximab, adalimumab, certolizumab, natalizumab, and etanercept were downloaded and analyzed with Microsoft Access. Full reports for all identified HSTCL cases were obtained from the FDA. RESULTS: Twenty-five cases of HSTCL were identified. Twenty-two (88%) patients had inflammatory bowel disease and three had rheumatoid arthritis. Four cases (16%) were in women and four patients were above 65 years of age. Twenty-four cases (96%) also received an immunomodulator (azathioprine, 6-mercaptopurine, or methotrexate). Two patients received adalimumab alone. CONCLUSION: HSTCL is no longer restricted to the previously identified risk group of young male patients, but can also occur in patients with rheumatoid arthritis, females and older adults receiving TNF-α inhibitors and immunomodulators. Improved disease outcomes using combination therapy should be tempered by the risk of developing HSTCL.

AB - BACKGROUND: Hepatosplenic T-cell lymphoma (HSTCL) is a rare, lethal disease generally seen in young male patients with inflammatory bowel disease. The study of biologic and immunomodulator naive patients in Crohn's disease (SONIC), advocates combining infliximab with an immunomodulator in moderate-to-severe Crohn's disease. Unfortunately, combined immunosuppression increases risk for HSTCL. We herein review all cases of HSTCL reported to the Food and Drug Administration (FDA) in patients receiving TNF-α inhibitors. METHODS: Individual reports from the FDA Adverse Event Reporting System database for lymphomas from the biological agents-infliximab, adalimumab, certolizumab, natalizumab, and etanercept were downloaded and analyzed with Microsoft Access. Full reports for all identified HSTCL cases were obtained from the FDA. RESULTS: Twenty-five cases of HSTCL were identified. Twenty-two (88%) patients had inflammatory bowel disease and three had rheumatoid arthritis. Four cases (16%) were in women and four patients were above 65 years of age. Twenty-four cases (96%) also received an immunomodulator (azathioprine, 6-mercaptopurine, or methotrexate). Two patients received adalimumab alone. CONCLUSION: HSTCL is no longer restricted to the previously identified risk group of young male patients, but can also occur in patients with rheumatoid arthritis, females and older adults receiving TNF-α inhibitors and immunomodulators. Improved disease outcomes using combination therapy should be tempered by the risk of developing HSTCL.

KW - cancer

KW - colitis

KW - hepatosplenic T-cell lymphoma

KW - inflammatory bowel disease

KW - lymphoma

KW - methotrexate

KW - older adults

KW - rheumatoid arthritis

KW - TNF-α inhibitors

KW - women

UR - http://www.scopus.com/inward/record.url?scp=80955142690&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80955142690&partnerID=8YFLogxK

U2 - 10.1097/MEG.0b013e32834bb90a

DO - 10.1097/MEG.0b013e32834bb90a

M3 - Article

VL - 23

SP - 1150

EP - 1156

JO - European Journal of Gastroenterology and Hepatology

JF - European Journal of Gastroenterology and Hepatology

SN - 0954-691X

IS - 12

ER -