Hepatosplenic T-cell lymphoma in patients receiving TNF-&agr; inhibitor therapy: expanding the groups at risk
Hepatosplenic T-cell lymphoma in patients receiving TNF-&agr; inhibitor therapy: expanding the groups at risk
复制标题
接受 TNF-α 治疗的患者发生肝脾 T 细胞淋巴瘤
DOI：
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发表时间：
2011
期刊：
影响因子：
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通讯作者：
E. Ehrenpreis
中科院分区：
文献类型：
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作者：
D. Parakkal;H. Sifuentes;Rumi Semer;E. Ehrenpreis
肝脾t细胞淋巴瘤（HSTCL）是一种罕见的致死性疾病，常见于年轻男性炎症性肠病患者。在克罗恩病（SONIC）的生物和免疫调节剂初始患者的研究中，提倡将英夫利昔单抗与免疫调节剂联合治疗中重度克罗恩病。不幸的是，联合免疫抑制增加了HSTCL的风险。我们在此回顾了所有报告给美国食品和药物管理局（FDA）的接受TNF-&agr；抑制剂。方法从FDA不良事件报告系统数据库中下载英夫利昔单抗、阿达木单抗、certolizumab、natalizumab和依那西普等生物制剂淋巴瘤的个别报告，并使用Microsoft Access进行分析。所有确定的HSTCL病例的完整报告均来自FDA。结果共确诊HSTCL 25例。22例（88%）患者患有炎症性肠病，3例患有类风湿关节炎。4例（16%）为女性，4例患者年龄在65岁以上。24例（96%）同时接受免疫调节剂（硫唑嘌呤、6-巯基嘌呤或甲氨蝶呤）。2例患者单独接受阿达木单抗治疗。结论HSTCL不再局限于先前确定的年轻男性患者的危险群体，也可发生在类风湿关节炎患者、女性和接受TNF-&agr治疗的老年人；抑制剂和免疫调节剂。使用联合治疗改善的疾病结果应受到发展为HSTCL的风险的影响。
Background Hepatosplenic T-cell lymphoma (HSTCL) is a rare, lethal disease generally seen in young male patients with inflammatory bowel disease. The study of biologic and immunomodulator naive patients in Crohn’s disease (SONIC), advocates combining infliximab with an immunomodulator in moderate-to-severe Crohn’s disease. Unfortunately, combined immunosuppression increases risk for HSTCL. We herein review all cases of HSTCL reported to the Food and Drug Administration (FDA) in patients receiving TNF-&agr; inhibitors. Methods Individual reports from the FDA Adverse Event Reporting System database for lymphomas from the biological agents − infliximab, adalimumab, certolizumab, natalizumab, and etanercept were downloaded and analyzed with Microsoft Access. Full reports for all identified HSTCL cases were obtained from the FDA. Results Twenty-five cases of HSTCL were identified. Twenty-two (88%) patients had inflammatory bowel disease and three had rheumatoid arthritis. Four cases (16%) were in women and four patients were above 65 years of age. Twenty-four cases (96%) also received an immunomodulator (azathioprine, 6-mercaptopurine, or methotrexate). Two patients received adalimumab alone. Conclusion HSTCL is no longer restricted to the previously identified risk group of young male patients, but can also occur in patients with rheumatoid arthritis, females and older adults receiving TNF-&agr; inhibitors and immunomodulators. Improved disease outcomes using combination therapy should be tempered by the risk of developing HSTCL.
DOI：
10.1016/j.cgh.2009.01.004
发表时间：
2009-08
期刊：
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
影响因子：
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作者：
Siegel CA;Marden SM;Persing SM;Larson RJ;Sands BE
通讯作者：
Sands BE