title: Prognosis of lymphoma in patients following treatment with 6-mercaptopurine/azathioprine for inflammatory bowel disease.
abstract: BACKGROUND
  6-Mercaptopurine (6-MP) and azathioprine (AZA) are effective for induction and maintenance therapy of Crohn's disease (CD) and ulcerative colitis (UC). There is an increased risk of lymphoma in patients with inflammatory bowel disease (IBD) treated with 6-MP/AZA. Little, however, is known about the prognosis of IBD patients treated with 6-MP/AZA who develop lymphoma.
  
  
  METHODS
  We conducted a retrospective review of 8780 records from three tertiary IBD centers and the records of 600 lymphoma patients from an academic Hematology and Oncology Center. The primary endpoint variable was survival of IBD patients with a lymphoma diagnosis treated or not treated with 6-MP/AZA. A secondary endpoint was the relative survival rate (by gender, race, and ethnicity) extrapolated from the Surveillance Epidemiology and End Results (SEER) database, computed for each subject.
  
  
  RESULTS
  Fourteen IBD patients were diagnosed with lymphoma. Twelve had CD and two had UC. Seven patients had treatment with 6-MP/AZA and seven had not. Two patients who received 6-MP/AZA died (both 1 year after diagnosis) and two patients who had not received 6-MP/AZA died (one after 2 years, another 3 years after diagnosis), all from lymphoma. Survival at last follow-up was similar to expected survival based on extrapolated SEER data for both 6-MP/AZA treated and untreated patients.
  
  
  CONCLUSIONS
  We found no differences of survival with lymphoma between IBD patients and expected survival for the general population. Also, the prognosis for those IBD patients treated with 6-MP/AZA was not worse than lymphoma patients not treated with 6-MP/AZA. Statistical analysis, however, was limited by the small sample size and heterogeneity of the patients studied.
authors.affiliation: North Shore University Hospital, Manhasset, New York, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Sultan
authors.forename: Burton I
authors.initials: BI
authors.lastname: Korelitz
authors.forename: Daniel
authors.initials: D
authors.lastname: Present
authors.forename: Seymour
authors.initials: S
authors.lastname: Katz
authors.forename: Suzanne
authors.initials: S
authors.lastname: Sunday
authors.forename: Iuliana
authors.initials: I
authors.lastname: Shapira
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001379:Azathioprine / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000401:mortality; D003424:Crohn Disease / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008223:Lymphoma / Q000139:chemically induced / Q000401:mortality*; D008297:Male; D015122:Mercaptopurine / Q000009:adverse effects*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D015122:Mercaptopurine; D001379:Azathioprine