Reversible Lymphoma in the Setting of Azathioprine Therapy for Crohn's Disease

Fatal Epstein-Barr Virus Primo Infection in a 25-Year-Old Man Treated with Azathioprine for Crohn's Disease

“…Azathioprine and 6-mercaptopurine are the first-choice therapeutic strategy for the treatment of steroid-refractory inflammatory bowel disease. These immunomodulating drugs can be associ- ated with the development of EBV-positive HLH or lymphoma (5,11,15). This is the first report of a fatal EBV primo infection case associated with the successive development of HLH and B-cell lymphoproliferative disorder in an adult patient treated with azathioprine for Crohn's disease.…”

The long-term risk of continuous immunosuppression using thioguanides in inflammatory bowel disease

“…The most common cancer reported in the literature in these patients is non-Hodgkin's lymphoma. Some of these have been reversible upon discontinuation of the drugs [Evans et al 2008;Larvol et al 1994]. A prospective cohort study of nearly 20,000 patients reported incidence rates of lymphoproliferative disorder of 0.90 per 1000 patient-years in those on thiopurines, 0.20/1000 patient-years in those who had discontinued thiopurine therapy, and 0.26/1000 patient-years in those who had never received thiopurines (p ¼ 0.0054) [Beaugerie et al 2006].…”

Posttransplant Lymphoproliferative Disorders in Patients with IBD on Immunosuppressive Treatment

“…1 Recently, several studies reported that the antitumor necrosis factor-alpha antibody, infliximab, is effective for refractory CD. 2,5 Although repeated infliximab infusions can induce rapid and sustained mucosal healing, 1,5,6 there is little evidence on whether infliximab infusion is effective for acute and massive GI bleeding in CD. In our patient, steroids therapy was ineffective, and recurrent bleeding occurred because of persistent mucosal inflammation with multiple ulcers.…”

“…1 We emphasize that these lesions had been reported in patients with IBD as well, specifically in those treated with azathioprine or 6-MP. 5,6 Moreover, a recent cohort study implicated such medications in the doubling of EBV-associated lymphomas, with an absolute risk of PTLD of 0.5% for patients with IBD treated with azathioprine or 6-MP. 7 Yet even if this figure was reproducible for other populations, it would be of little significance when compared to the benefit obtained with these drugs.…”