Abstract
Purpose: An increased risk of lymphoma in patients with Crohn's disease (CD) and ulcerative colits (UC) has never been confirmed. However, treatment of CD with 6-mercaptopurine (6MP) and azathioprine (AZA) has been associated with a four fold increase in the risk of lymphoma compared to non-treated patients and the general population. Lymphoma occurs in 4 out of every 10,000 CD patients treated with 6MP/AZA. Despite this small number, lymphoma remains a feared complication of treatment. Recent reports of hepatosplenic T cell lymphoma in patients treated with both 6MP/AZA and infliximab have worsened these fears. Currently, little is known about the prognosis of lymphoma occurring in the inflammatory bowel disease (IBD) population, specifically those treated with 6MP/AZA. Methods: A retrospective case series of IBD patients at three academic centers were analyzed from a database of 8,780 total records. All patients with a diagnosis of lymphoma were identified and analyzed for IBD type, medication use, lymphoma type and outcome following medical treatment. Another database of 600 lymphoma patients from an academic Hematology and Oncology center was searched for IBD patients and analyzed in the same fashion. Results: In all, 14 patients with a diagnosis of lymphoma were identified, 12 with CD and 2 with UC. The one female case had CD. There was only one Hodgkin's lymphoma. Cases are summarized in the table below. Conclusion: While the number of IBD patients who develop lymphoma remains small, concern among patients and practitioners remains disproportionately high. While hepatosplenic T cell lymphoma is rapidly progressive and uniformly fatal, there is no evidence that prior 6MP/AZA use alone and non-Hodgkin's lymphoma follows a similar severe course. From our own series only two cases treated with 6MP/AZA exhibited a rapid clinical decline. Our data suggest that those who developed lymphoma after treatment with 6MP/AZA had a prognosis no more ominous than those not so treated.
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