title: A systematic review of factors that contribute to hepatosplenic T-cell lymphoma in patients with inflammatory bowel disease.
abstract: OBJECTIVE
  Hepatosplenic T-cell lymphoma (HSTCL) is a rare and usually fatal lymphoma that primarily affects men younger than 35 years old. Treatment of patients with inflammatory bowel disease (IBD) using antibodies to tumor necrosis factor (anti-TNFs) and thiopurines has been associated with HSTCL. We investigated the medications, duration of therapy, and ages of patients associated with HSTCL.
  
  
  METHODS
  We collected and analyzed data on the association between HSTCL, and anti-TNF and thiopurine therapies in patients with IBD from published reports and the MedWatch reporting system of the US Food and Drug Administration.
  
  
  RESULTS
  Of 36 patients with HSTCL, 20 received therapy with infliximab and a thiopurine and 16 received a thiopurine as monotherapy for IBD. Four patients who had been treated with infliximab and a thiopurine also received adalimumab. One of these patients had been given infliximab, adalimumab, and natalizumab. Of 31 patients of known gender, only 2 were female. Twenty-seven of the 30 patients of known age were younger than 35 years old.
  
  
  CONCLUSIONS
  Most patients with HSTCL who received long-term therapy (at least 2 y) with thiopurines for IBD were men younger than 35 years old. There were no reported cases of HSTCL in patients with IBD who received only anti-TNF therapy. Physicians should consider giving thiopurines and anti-TNF agents to young male patients with IBD only in cases in which a clear benefit is expected, such as in early stage disease in untreated patients or possibly in very severe cases.
authors.affiliation: Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Kotlyar
authors.forename: Mark T
authors.initials: MT
authors.lastname: Osterman
authors.forename: Robert H
authors.initials: RH
authors.lastname: Diamond
authors.forename: David
authors.initials: D
authors.lastname: Porter
authors.forename: Wojciech C
authors.initials: WC
authors.lastname: Blonski
authors.forename: Mariusz
authors.initials: M
authors.lastname: Wasik
authors.forename: Sami
authors.initials: S
authors.lastname: Sampat
authors.forename: Manuel
authors.initials: M
authors.lastname: Mendizabal
authors.forename: Ming V
authors.initials: MV
authors.lastname: Lin
authors.forename: Gary R
authors.initials: GR
authors.lastname: Lichtenstein
mesh_terms: D000068879:Adalimumab; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects* / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy*; D000069285:Infliximab; D008113:Liver Neoplasms / Q000139:chemically induced / Q000453:epidemiology*; D016399:Lymphoma, T-Cell / Q000139:chemically induced / Q000453:epidemiology*; D011687:Purines / Q000009:adverse effects / Q000627:therapeutic use; D013160:Splenic Neoplasms / Q000139:chemically induced / Q000453:epidemiology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014481:United States
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007155:Immunologic Factors; D011687:Purines; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; C030985:purine