Systematic Review: Comparison of Outcomes of IBD-related Hepatosplenic T-Cell Lymphoma (HSTCL) versus non-IBD Related HSTCL

Abstract

Purpose: Hepatosplenic T-cell lymphoma is a serious and often fatal condition seen in patients with Inflammatory Bowel Disease taking thiopurine therapy. To date, there have been no comparisons of outcomes of IBD-related and non-IBD related HSTCL. Methods: Eight previously unpublished cases of non-IBD HSTCL were seen at Memorial Sloan-Kettering Cancer Center. IRB approval was obtained. In addition, a systematic review of the literature was performed; MEDLINE was searched with the keywords “hepatosplenic” and “lymphoma” and English-language case series with 5 or more patients were included. Data was compared to a recent review of clinical outcomes of IBD-associated HSTCL (Kotlyar 2010, Clin Gastroenterol Hepatol). Demographics analyzed included gender, three age ranges (0-30, 31-50, 51+), clinical response (complete response, partial response, or progressive disease), mortality, and months of overall survival amongst patients who expired. Results were compared using the GraphPad Prism program, with paired two tailed t-tests. Results: Of 295 citations, 4 were selected (Falchook 2009, Ann Oncol; Belhadj 2003, Blood; Wei 2005, World J Gastroenterol; Macon 2001, Am J Surg Pathol). There were 63 non-IBD HSTCL cases identified, and 36 IBD-related HSTCL cases. Significant differences were noted between non-IBD and IBD related HSTCL with regards to the percentage of male patients (62.7% vs. 93.5% of patients respectively, p<0.0017), and ages of patients (median 34 vs. 22.5 years respectively, p<0.02) showing differences. Although not significant (p<0.118), there was a trend of higher overall survival in patients who expired with non-IBD HSTCL (median survival 9.95 months) as compared to those with IBD-related HSTCL (median survival 5 months). There was no difference in mortality between groups (non-IBD HSTCL 80.7% vs. IBD-related HSTCL 84.4%, p<0.669). Conclusion: IBD-associated HSTCL seems to affect more men than women and at a younger age as compared with non-IBD HSTCL; however, the prognosis of patients in both IBD-related and non IBD-related HSTCL seems similar with treatment. Further prospective studies of lymphoma in IBD, and a prospective registry of HSTCL cases may shed more light on this rare but lethal disease.Table: Table. Comparison of outcomes of HSTCLDisclosure: David Kotlyar: NO financial relationship with a commercial interest Robert Hirten: NO financial relationship with a commercial interest Steven Horwitz: YES financial relationship with a commercial interest;Merck & Co: Self: Consulting fee:Consulting;Allos: Self:Consulting fee:Grant/Research Support; Celgene Corporation:Self:Consulting fee:Grant/Research Support;Seattle Genetics:Self:Consulting fee:Consulting;Millenium:Self:Consulting fee:Consulting Wojciech Blonski: NO financial relationship with a commercial interest Gary Lichtenstein: YES financial relationship with a commercial interest;UCB, Inc.: Other financial benefit not in list (use freeform entry below):Grant/Research Support;Abbott Laboratories:Other financial benefit not in list (use freeform entry below):Grant/Research Support;Abbott Laboratories:Other financial benefit not in list (use freeform entry below):Consulting;Bristol-Myers Squibb Co.: Other financial benefit not in list (use freeform entry below):Grant/Research Support;Centocor/Orthobiotech, Inc.:Other financial benefit not in list (use freeform entry below):Consulting;Centocor/Orthobiotech, Inc.:Other financial benefit not in list (use freeform entry below):Grant/Research Support;Elan Pharmaceuticals, Inc.: Other financial benefit not in list (use freeform entry below):Consulting;Ferring Pharmaceuticals Inc: Other financial benefit not in list (use freeform entry below):Consulting;Millennium Research Group:Other financial benefit not in list (use freeform entry below):Consulting;Procter & Gamble Pharmaceuticals: Other financial benefit not in list (use freeform entry below):Grant/Research Support;Procter & Gamble Pharmaceuticals: Other financial benefit not in list (use freeform entry below):Consulting;Procter & Gamble Pharmaceuticals: Other financial benefit not in list (use freeform entry below):Grant/Research Support;Prometheus Laboratories Inc.:Other financial benefit not in list (use freeform entry below):Consulting;Prometheus Laboratories Inc.:Other financial benefit not in list (use freeform entry below):Grant/Research Support;Salix Pharmaceuticals, Inc.:Other financial benefit not in list (use freeform entry below):Grant/Research Support;Salix Pharmaceuticals, Inc.: Other financial benefit not in list (use freeform entry below):Consulting;Salix Pharmaceuticals, Inc.:Other financial benefit not in list (use freeform entry below):Consulting;Warner Chilcotte:Other financial benefit not in list (use freeform entry below):Consulting;Schering-Plough Corp.:Other financial benefit not in list (use freeform entry below):Consulting;Shire Pharmaceuticals Inc.: Other financial benefit not in list (use freeform entry below):Grant/Research Support;Shire Pharmaceuticals Inc.:Other financial benefit not in list (use freeform entry below):Consulting;Wyeth Pharmaceuticals:Other financial benefit not in list (use freeform entry below):Consulting;UCB, Inc.:Other financial benefit not in list (use freeform entry below):Consulting;Warner Chilcotte: Other financial benefit not in list (use freeform entry below):Grant/Research Support;Warner Chilcotte:Other financial benefit not in list (use freeform entry below):Consulting.