Lymphoma risk in children and young adults with inflammatory bowel disease: Analysis of a large single-center cohort
Lymphoma risk in children and young adults with inflammatory bowel disease: Analysis of a large single-center cohort
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DOI：
10.1002/ibd.21844
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发表时间：
2012-05-01
影响因子：
4.9
通讯作者：
Bousvaros, Athos
中科院分区：
文献类型：
--
作者：
Ashworth, Lori A.;Billett, Amy;Bousvaros, Athos
背景：先前的研究表明患有炎症性肠病（IBD）的成人患淋巴瘤的风险增加。在IBD儿童中也报告了淋巴瘤病例。然而，在儿童中，与药物暴露相关的淋巴瘤的确切风险尚未确定。研究方法：我们对1979年至2008年期间在波士顿儿童医院接受评估的1560名IBD儿童和年轻人进行了单中心回顾性研究。其中，186例患者因诊断错误、一次性第二意见访视或医院记录缺失而被排除。其余1374例患者进行了图表审查，以确定他们在我们的机构接受临床护理时是否发生淋巴瘤以及暴露于各种IBD药物的持续时间。淋巴瘤发生率以IBD中使用的每类药物的暴露患者年计算。结果如下：在1374例患者中（741例男性;诊断时年龄12.1 ± 4.0岁; 791例克罗恩病[CD]，535例溃疡性结肠炎[UC]，48例IBD未分类），我们在6624患者年的随访中确定了2例发生淋巴瘤的患者（1例霍奇金淋巴瘤，1例间变性大细胞淋巴瘤）（每例患者平均随访时间为4.8年）。两名患者均为男性（淋巴瘤发作时年龄为12岁和18岁），正在接受硫嘌呤治疗，但在癌症诊断时尚未接受生物制剂治疗。他们都接受了化疗，并且自诊断后32+和76+个月没有癌症。接受硫嘌呤治疗患者的淋巴瘤绝对发病率为4.5/10，000患者-年，而预期发病率为0.58/10，000患者-年，标准化发病率比（SIR）为7.51（95%置信区间[CI] 0.7441.98）。结论：IBD儿童淋巴瘤的总体风险较低，在我院30年期间仅观察到2例。接受硫嘌呤的儿童的淋巴瘤风险（由SIR估计）与成人研究中报告的风险相当。虽然接受硫嘌呤治疗的儿童患淋巴瘤的风险可能会增加，但在这个大型队列中，风险没有达到统计学显著性。（Inflamm Bowel Dis 2011;）
Background: Prior studies suggest an increased risk of lymphoma in adults with inflammatory bowel disease (IBD). Cases of lymphoma have also been reported in children with IBD. However, the precise risk of lymphoma in relation to drug exposure has not been ascertained in children. Methods: We conducted a single-center, retrospective study of 1560 children and young adults with IBD evaluated at Children's Hospital Boston between 1979 and 2008. Of this group, 186 patients were excluded due to incorrect diagnosis, one-time second-opinion visits, or missing hospital records. The remaining 1374 patients had charts reviewed to determine whether lymphoma developed while they were receiving their clinical care at our institution and the duration of exposure to various IBD medications. The rate of lymphoma was calculated in patient-years of exposure for each class of medications utilized in IBD. Results: Of 1374 patients (741 male; age at diagnosis 12.1 +/- 4.0 years; 791 Crohn's disease [CD], 535 ulcerative colitis [UC], 48 IBD unclassified), we identified two patients who developed lymphoma (one Hodgkin, one anaplastic large cell), in 6624 patient-years of follow-up (mean duration follow-up 4.8 years per patient). Both patients were males (ages 12 and 18 years at time of lymphoma onset) and were receiving thiopurines but had not yet received biologics at the time of their cancer diagnosis. They were both treated with chemotherapy and are alive without cancer 32+ and 76+ months since diagnosis. The absolute incidence rate of lymphoma for patients having received thiopurines was 4.5 per 10,000 patient-years compared to the expected rate of 0.58 per 10,000 patient-years, with a standardized incidence ratio (SIR) of 7.51 (95% confidence interval [CI] 0.7441.98). Conclusions: The overall risk of lymphoma in children with IBD is low, with only two cases seen in our hospital over a 30-year period. The lymphoma risk (as estimated by SIR) in children receiving thiopurines is comparable to that reported in studies of adults. While there may be an increased risk of lymphoma in children treated with thiopurines, the risk did not reach statistical significance in this large cohort. (Inflamm Bowel Dis 2011;)