Document Detail

Hepatosplenic T-cell lymphoma and inflammatory bowel disease.
MedLine Citation:
PMID:  21122554     Owner:  NLM     Status:  In-Process    
OBJECTIVE: This article reviews the current literature and knowledge about hepatosplenic T-cell lymphoma (HSTCL), providing an overview of the clinical features, a description of its pathology and immunophenotypic traits in relation to other lymphomas. In addition, we explore the history of reported cases of hepatosplenic T-cell lymphoma in relation to the possible existence of a causal relationship between infliximab use and HSTCL. The treatments for HSTCL will be briefly addressed.
METHODS: A comprehensive literature search using multiple databases was performed. Keyword search phrases including "lymphoma," "hepatosplenic T-cell lymphoma," "Inflammatory bowel disease," "6-mercaptopurine," and "infliximab" were used in various combinations. In addition references from published papers were reviewed as well.
RESULTS: There are over 200 reported cases of HSTCL. Only 22 cases of hepatosplenic T-cell lymphoma are associated with IBD treatment. Clinicians usually reserve immunomodulators and biologics for moderate to severe IBD cases. The ultimate goal of therapy is to control inflammation and therefore allow mucosal healing. IBD patients demonstrating mucosal healing are less likely to undergo surgery and experience complications related to their disease. We manipulate the immune system with corticosteroids, immunomodulators, and biologics, therefore causing bone marrow suppression. With bone marrow suppression, malignant degeneration may begin through selective uncontrolled cell proliferation, initiating HSTCL development in the genetically susceptible.
CONCLUSION: Hepatosplenic T-cell lymphoma is a rare disease, often with a poor outcome. With the increasing number of reported cases of HSTCL linked to the use of infliximab, adalimumab, and AZA/6-MP, there appears to be an undeniable association of HSTCL development with the use of these agents. This risk is unquantifiable. When considering the rarity of cases and the multiple complications with uncontrolled disease, however, the benefit of treatment far outweighs the risk.
Anne Thai; Thomas Prindiville
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Publication Detail:
Type:  Journal Article     Date:  2010-06-25
Journal Detail:
Title:  Journal of Crohn's & colitis     Volume:  4     ISSN:  1876-4479     ISO Abbreviation:  J Crohns Colitis     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-12-02     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101318676     Medline TA:  J Crohns Colitis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  511-22     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.
University of California, Davis Medical Center (UCDMC), Internal Medicine, 4150 V Street, Suite 3100, Sacramento, CA 95817, United States.
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