title: Hepatosplenic T-cell lymphoma, immunosuppressive agents and biologicals: what are the risks?
abstract: We present three cases of the rare hepatosplenic T-cell lymphoma (HSTCL); two patients suffering from Crohn disease who developed HSTCL on azathioprine without exposure to biologicals, and a third patient who had psoriasis treated using etanercept, cyclosporine and methotrexate. The evidence for an association between HSTCL and immunosuppressive drugs and biologicals is reviewed. We argue for improved pharmacovigilance processes to help determine the benefit to risk ratios for the use of these and other new agents.
authors.affiliation: Gastroenterology and Hepatology Unit, Therapeutic Goods Administration, Canberra, Australian Capital Territory, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Subramaniam
authors.forename: D
authors.initials: D
authors.lastname: Yeung
authors.forename: F
authors.initials: F
authors.lastname: Grimpen
authors.forename: J
authors.initials: J
authors.lastname: Joseph
authors.forename: K
authors.initials: K
authors.lastname: Fay
authors.forename: M
authors.initials: M
authors.lastname: Buckland
authors.forename: D
authors.initials: D
authors.lastname: Talaulikar
authors.forename: J
authors.initials: J
authors.lastname: Elijah
authors.forename: A C
authors.initials: AC
authors.lastname: Clarke
authors.forename: P
authors.initials: P
authors.lastname: Pavli
authors.forename: J
authors.initials: J
authors.lastname: Moore
mesh_terms: D000328:Adult; D001688:Biological Products / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008113:Liver Neoplasms / Q000139:chemically induced / Q000175:diagnosis*; D016399:Lymphoma, T-Cell / Q000139:chemically induced / Q000175:diagnosis*; D008297:Male; D012307:Risk Factors; D013160:Splenic Neoplasms / Q000139:chemically induced / Q000175:diagnosis*
chemical_list: D001688:Biological Products; D007166:Immunosuppressive Agents
keywords: biologicals; hepatosplenic T-cell lymphoma; immunosuppression; inflammatory bowel disease; psoriasis