Lymphoma in Pediatric-Onset Inflammatory Bowel Disease Treated with Infliximab Monotherapy: A Case Series.

Feb 18, 2021

Contributor: Alejandro Llanos-Chea,Jason M Shapiro,Rachel W Winter,Logan Jerger,Timothy Menz,Meghan Gibson,Alison M Friedmann,Diana Treaba,Konstantinos Papamichael,Adam S Cheifetz,Sonia Friedman,Matthew J Hamilton,Harland S Winter

Lymphoma in Pediatric-Onset Inflammatory Bowel Disease Treated with Infliximab Monotherapy: A Case Series.

Inflammatory bowel diseases (IBD) are often treated with anti-tumor necrosis factor alpha (anti-TNFα) medications. Concomitant treatment of IBD with anti-TNFα agents and immunomodulators appears to be associated with an increased risk for lymphoma.
Patients who developed lymphoma while on monotherapy with an anti-TNFα agent were identified at three centers. Institutional Review Board approval was obtained.
Five adolescents and young adult patients with pediatric-onset IBD who were treated with infliximab (IFX) without exposure to thiopurines were subsequently diagnosed with lymphoma. Three of the five patients had bone involvement at presentation. Epstein-Barr virus was positive in 2 cases. Median time from diagnosis of IBD and exposure to IFX prior to diagnosis of lymphoma was 5 and 4.3 years, respectively.
This case series reports long-term follow-up for young patients with IBD who were treated with IFX monotherapy and developed lymphoma. Three of the five patients had bone involvement. In general, the risk of lymphoma following exposure to anti-TNFα medications alone remains low, but the incidence of primary bone lymphomas in IBD has not been reported. Studies examining longer exposure times may be needed to determine the true lymphoma risk in patients treated with IFX monotherapy.

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About The Expert

Alejandro Llanos-Chea

Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, CRPZ 5-560, 175 Cambridge Street, Boston, MA, 02114, USA.

Harvard Medical School, CRPZ 5-560, 175 Cambridge Street, Boston, MA, 02114, USA.

Jason M Shapiro

Division of Pediatric Gastroenterology, Nutrition, and Liver Diseases, Hasbro Children’s Hospital and Rhode Island Hospital, Hasbro Lower Level, 593 Eddy St., Providence, RI, 02903, USA.

Warren Alpert Medical School of Brown University, Hasbro Lower Level, 593 Eddy St., Providence, RI, 02903, USA.

Rachel W Winter

Division of Gastroenterology, Brigham and Women’s Hospital, Crohn’s and Colitis Center, 75 Francis Street, Boston, MA, 02115, USA.

Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.

Logan Jerger

Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, CRPZ 5-560, 175 Cambridge Street, Boston, MA, 02114, USA.

Harvard Medical School, CRPZ 5-560, 175 Cambridge Street, Boston, MA, 02114, USA.

Timothy Menz

Division of Pediatric Gastroenterology, Nutrition, and Liver Diseases, Hasbro Children’s Hospital and Rhode Island Hospital, Hasbro Lower Level, 593 Eddy St., Providence, RI, 02903, USA.

Warren Alpert Medical School of Brown University, Hasbro Lower Level, 593 Eddy St., Providence, RI, 02903, USA.

Meghan Gibson

Division of Pediatric Gastroenterology, Nutrition, and Liver Diseases, Hasbro Children’s Hospital and Rhode Island Hospital, Hasbro Lower Level, 593 Eddy St., Providence, RI, 02903, USA.

Warren Alpert Medical School of Brown University, Hasbro Lower Level, 593 Eddy St., Providence, RI, 02903, USA.

Alison M Friedmann

Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, CRPZ 5-560, 175 Cambridge Street, Boston, MA, 02114, USA.

Harvard Medical School, CRPZ 5-560, 175 Cambridge Street, Boston, MA, 02114, USA.

Diana Treaba

Department of Pathology, Rhode Island Hospital, The Miriam Hospital, Brown University, Box G-E5, Providence, RI, 02912, USA.

Warren Alpert Medical School of Brown University, Brown University, Box G-E5, Providence, RI, 02912, USA.

Konstantinos Papamichael

Division of Gastroenterology, Beth Israel Deaconess Medical Center, Beth Israel Deaconess Med Ctr., 330 Brookline Avenue, Rabb Rose 1, Boston, MA, 02215, USA.

Harvard Medical School, Beth Israel Deaconess Med Ctr., 330 Brookline Avenue, Rabb Rose 1, Boston, MA, 02215, USA.

Adam S Cheifetz

Division of Gastroenterology, Beth Israel Deaconess Medical Center, Beth Israel Deaconess Med Ctr., 330 Brookline Avenue, Rabb Rose 1, Boston, MA, 02215, USA.

Harvard Medical School, Beth Israel Deaconess Med Ctr., 330 Brookline Avenue, Rabb Rose 1, Boston, MA, 02215, USA.

Sonia Friedman

Division of Gastroenterology, Brigham and Women’s Hospital, Crohn’s and Colitis Center, 75 Francis Street, Boston, MA, 02115, USA.

Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.

Matthew J Hamilton

Division of Gastroenterology, Brigham and Women’s Hospital, Crohn’s and Colitis Center, 75 Francis Street, Boston, MA, 02115, USA.

Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.

Harland S Winter

Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, CRPZ 5-560, 175 Cambridge Street, Boston, MA, 02114, USA. hwinter@mgh.harvard.edu.

Harvard Medical School, CRPZ 5-560, 175 Cambridge Street, Boston, MA, 02114, USA. hwinter@mgh.harvard.edu.

References

PubMed