Case Report

Abstract

The use of the chimeric monoclonal antibody against tumor necrosis factor (TNF) known as infliximab has been scrutinized for its possible association with malignancy. The National Institutes of Health Surveillance Epidemiology and End Result (SEER) database cites 6 patients who developed lymphoma out of 2,427 patients treated in clinical trials with infliximab. The three major studies of the safety and efficacy of infliximab, the ACCENT I trial, the Mayo Clinic experience in 500 patients, and the ACCENT II trial, all found a less than 1% rate of lymphoma development which could have been related to infliximab therapy. Our case represents the only reported case of multiple myeloma arising in the setting of infliximab treatment for Crohn's disease. A 50 year old white female had been on escalating doses of infliximab for 4.5 years when she was diagnosed with stage III multiple myeloma. It is highly probable, but difficult to be certain that infliximab therapy had a causal role in our patient developing multiple myeloma. The pathogenesis may be related to decreased apoptosis of plasma cell lines. Since it is possible that a causal association exists between infliximab therapy and multiple myeloma, perhaps additional screening measures such as urine protein and/or urinalysis with sulfosalicylic acid should be done in patients with Crohn's disease on infliximab.