Demographic Difference of Hepatosplenic T-Cell Lymphoma (HSTCL) Versus Non-HSTCL Lymphoma in Patients with IBD Receiving Thiopurines: A Population Cohort Analysis

Field: Medicine (Health Sciences)

Purpose: Lymphoma remains a serious complication of thiopurine use in IBD. To date there has been no formal analysis comparing demographic characteristics in population cohort studies of patients with hepatosplenic T cell lymphoma (HSTCL) and those with other types of lymphoma seen in IBD patients treated with thiopurines. Methods: An analysis of all available primary data from population cohort studies was performed in patients with non-HSTCL on azathioprine and compared to available published data available from all published data from studies involving IBD patients with HSTCL (all patients had received azathioprine). We performed a systematic review and searched MEDLINE for: “lymphoproliferative and thiopurines”; “thiopurine and lymphoma” and “azathioprine and lymphoma”. Included citations were population based studies examining IBD, evaluated cancer as an outcome, and included demographic characteristics of patients who developed lymphoma. In addition, we included primary data from the ENEIDA database, a population based database from Spain. The ENEIDA database is 3,900 patient national database from Spain with a follow-up time of 9.54 years. We also included primary data from a population database from Olmstead County MN created by the Mayo Clinic of 165 patients over 4.7 years. Demographic characteristics of patients with HSTCL are published in a complete manuscript in a recent systematic review (Kotlyar 2011 CGH). Results: Of 606 citations, 3 citations were included (Lewis Gastro. 2001, Beaugerie Lancet 2009, Vos Inf Bowel Dis. 2011). See Table 1. There were 34 cases of non-HSTCL identified and 36 HSTCL cases identified. Of non-HSTCL, 55.9% were men while 93.5% of pts. with HSTCL were men (p<0.0004). Of those with non-HSTCL, 20.6% were 30 or under while 66.7% of HSTCL were 30 or under (p<0.0002). Also 47.1% of non-HSTCL were older than 50 while only 6.7% of HSTCL were older than 50 (p<0.0001). Differences in patients between ages 31-50 were not significant, nor were the distribution of UC or CD in either lymphoma.Table: No Caption available.Conclusion: Non-HSTCL lymphoma affects older patients with IBD more than HSTCL. In addition HSTCL shows a strong male predominance as compared to non-HSTCL. Since HSTCL usually affects men under 35 an appropriate caution is needed with the use of thiopurines in this population. Additional studies are needed to determine the risk/benefit ratio in older adults of both Hodgkin's Disease and non-Hodgkin lymphoma. Disclosure: Gary R. Lichtenstein, MD - Abbott Corporation-Consultant; Alaven-Consultant; Bristol-Myers Squibb-Research; Centocor Orthobiotech-Consultant, Research; Elan-Consultant; Ferring-Consultant, Research; Millenium Pharmaceuticals-Consultant; Proctor and Gamble-Consultant, Research; Prometheus Laboratories, Inc.-Consultant, Research; Salix Pharmaceuticals-Consultant, Research; Schering-Plough Corporation-Consultant; Shire Pharmaceuticals-Consultant, Research; UCB-Consultant, Research; Warner Chilcotte-Consultant, Research; Wyeth-Consultant.