Hepatosplenic T-cell lymphoma in patients receiving TNF-&agr; inhibitor therapy: expanding the groups at risk

@article{Parakkal2011HepatosplenicTL,
  title={Hepatosplenic T-cell lymphoma in patients receiving TNF-\&agr; inhibitor therapy: expanding the groups at risk},
  author={Deepak Parakkal and Humberto Sifuentes and Rumi Semer and Eli D. Ehrenpreis},
  journal={European Journal of Gastroenterology \& Hepatology},
  year={2011},
  volume={23},
  pages={1150–1156}
}
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… 
Hepatosplenic T-cell lymphoma in a 47-year-old Crohn’s disease patient on thiopurine monotherapy
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A 47-year-old patient with Crohn’s disease (CD) who developed HSTCL after having been treated with thiopurine monotherapy for 14 years is described.
Effect of chidamide on treating hepatosplenic T-cell lymphoma: A case report
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The novel agent chidamide can be used in HSTCL to achieve deep remission and improve the duration of response and overall survival.
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A 41yearold Japanese man presented with severe fatigue and high fever for 1 month, and after treatment with prednisolone (PSL) and azathioprine (AZA), he had gone into remission and no relapse of DM was observed.
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A systematic review of all previously published reports of allo-SCT in HSTCL including four previously unpublished cases from the authors' institution is provided to suggest potent graft-versus-lymphoma effects.
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TLDR
It is argued for improved pharmacovigilance processes to help determine the benefit to risk ratios for the use of these and other new agents, including etanercept, cyclosporine and methotrexate.
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Lymphoproliferative disorders in inflammatory bowel disease patients on immunosuppression: Lessons from other inflammatory disorders.
TLDR
Evidence is available to demonstrate that certain immune suppressants such as cyclosporine and T-lymphocyte modulators in particular are associated with an increased risk of PTLD development, and high doses of immunosuppressive agents and multiple immunOSuppressive agent use are also linked to increasedPTLD development.
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The presence of atypical infiltrate in the intestinal mucosa of IBD patients warrants EBV testing and reduction of immunosuppression is an effective strategy to achieve morphological normalization and loss of EBV.
T-Cell Non-Hodgkin's Lymphomas Reported to the FDA AERS With Tumor Necrosis Factor-Alpha (TNF-α) Inhibitors: Results of the REFURBISH Study
TLDR
Risk of T-cell NHL is increased with T NF-α inhibitor use in combination with thiopurines but not with TNF-α inhibitors alone, and this risk was calculated using Fisher's exact test using 5-aminosalicylates as control drugs.
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