European Evidence-based Consensus: Inflammatory Bowel Disease and Malignancies

The Pattern of Underlying Cause of Death in Patients with Inflammatory Bowel Disease in England: A Record Linkage Study

“…We are unfortunately unable to comment on changes in cause of death as we did not previously have this data. It is reassuring to note however that notwithstanding the wellrecognised risks of immunosuppression and biologics and their added risk of infection 25 and haematological malignancy 26 , they were not associated with an additional risk of death among IBD patients compared to non-IBD patients and remain uncommon causes of death in IBD patients.…”

Hodgkin's Lymphoma in Crohn's Disease Treated with Infliximab

“…However, these results must also be analyzed with caution because in most series, the number of patients is too low to detect significant differences [10] .…”

“…The latest ECCO guidelines on this subject try to bring a consensus, stating that patients with IBD have a risk of developing hematological malignancies and CD patients are more likely to be at risk of lymphoma, in particular non-Hodgkin's lymphoma [10] . However, it is difficult to distinguish the role of inflammation and immunomodulators in IBD-associated hematological diseases [1] .…”

“…The authors found no difference between the group that stopped thiopurines and those who had never been treated with them [12] . Lymphomas have also been reported in patients treated with anti-tumor necrosis factor-α (TNF-α) drugs, which could act by decreasing apoptosis and allowing proliferation of neoplastic cells [2] , but in most studies, anti-TNF-α appears to have no correlation with lymphomas [10] . In a register-based cohort study conducted by Nyboe Andersen et al [13] , 56,146 patients were included and 8 cases of lymphomas, with 2 HL, were diagnosed.…”

“…Combination therapy must be avoided in young male patients to prevent the emergence of hepatosplenic lymphoma. In EBV-seronegative patients, thiopurines must be avoided and anti-TNF-α monotherapy should be preferred, thus lowering the risk of post-mononucleosis lymphomas [10] . Monitoring EBV viral load is recommended in posttransplant settings, but this approach has not been validated for patients with IBD, as a transitory increase can happen during flares [3] .…”