Excess primary intestinal lymphoproliferative disorders in IBD

This month's issue of the Inflammatory Bowel Diseases examines excess primary intestinal lymphoproliferative disorders in patients with inflammatory bowel disease.

It remains to be shown whether inflammatory bowel disease (IBD) is associated with an increased risk of primary intestinal lymphoproliferative disorders.

Dr Laurent Beaugerie and colleagues from France assessed this risk in the CESAME French nationwide prospective observational cohort.
 
In all, 680 gastroenterologists enrolled 19,486 patients with IBD from 2004 to 2005, with follow-up that ended on 2007.

Available biopsy samples and surgical specimens from patients with primary intestinal lymphoproliferative disorders were centralized for review.

The incidence of primary intestinal lymphoproliferative disorders was 0.12 per 1000 patient-years

Inflammatory Bowel Disease

The reference incidence of primary intestinal lymphoproliferative disorders in the general population was obtained from the Côte d'Or registry, and was used as a comparator to assess the standardized incidence ratio.

The researchers explored the influence of thiopurine exposure in a nested case-control study.
 
In the CESAME population the crude incidence of primary intestinal lymphoproliferative disorders was 0.12 per 1000 patient-years, with a corresponding standardized incidence ratio of 17.5.

The research team found that the risk was highest in patients exposed to thiopurines, while it did not reach statistical significance in patients naïve to thiopurines.

The team noted that the odds ratio associated with ongoing thiopurine exposure was 2.97.

All 14 cases of primary intestinal lymphoproliferative disorders were non-Hodgkin's B-cell lymphoproliferative disorders, 79% occurred in males, 86% arose in IBD lesions, and 46% were Epstein–Barr virus-positive.

The researchers observed that 11 cases occurred in patients with Crohn's disease.

The team observed that the mean age at primary intestinal lymphoproliferative disorders diagnosis was 55 years, and the median time since IBD onset was 8 years.
 
Dr Beaugerie's team concludes, "Patients with IBD have an increased risk of developing primary intestinal lymphoproliferative disorders."