Area Editoriale
Dei 36 pazienti con IBD che hanno sviluppato un linfoma epatosplenico finora descritti:
- 16 assumevano solo tiopurine, i restanti 20 tiopurine in combinazione con farmaci anti-TNF
- più del 90 per cento erano maschi e nel 90 per cento dei casi il tumore è esordito prima dei 35 anni.
- in 31 dei 36 pazienti la durata del trattamento con tiopurine era stata superiore a 4 anni
Sulla base di questi dati emerge la raccomandazione di utilizzare con prudenza le tiopurine per periodi prolungati nei pazienti maschi giovani, anche se il rischio assoluto di sviluppare questo tipo di tumore rimane molto basso (meno di una caso su 3.000) anxhe in questo sottogruppo di pazienti
DS Kotlyar, MT Osterman, RH Diamond, D Porter, WC Blonski, M Wasik, S Sampat, M Mendizabal, MV Lin, GR Lichtenstein. A Systematic Review of Factors That Contribute to Hepatosplenic T-Cell Lymphoma in Patients With Inflammatory Bowel Disease. Clin Gastroenterolol Hepatol. 2011;9:36-41
BACKGROUND & AIMS: 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 a sociated 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