Risk of lymphoma in inflammatory bowel disease

Edward Vincent Loftus, Jr, William J. Tremaine, Thomas Matthew Habermann, W. Scott Harmsen, Alan R. Zinsmeister, William J. Sandborn

Research output: Contribution to journalArticle

145 Citations (Scopus)

Abstract

OBJECTIVE: Inflammatory bowel disease with a subsequent diagnosis of non-Hodgkin's lymphoma has been reported. There is concern that the risk of developing lymphoma will rise with increasing use of immune modifier therapy. We determined the risk of non-Hodgkin's lymphoma in an U.S. population-based inception cohort, and evaluated the association between inflammatory bowel disease and lymphoma in our referral practice. METHODS: The records of all incidence cases of inflammatory bowel disease in Olmsted County, Minnesota, between 1950 and 1993 were reviewed for the diagnosis of lymphoma. Standardized incidence ratios (observed/expected) were used to estimate relative risk. In addition, the clinical features and outcomes of all patients with inflammatory bowel disease and lymphoma seen at Mayo Clinic between 1976 and 1997 were reviewed. RESULTS: Among 454 county residents diagnosed with inflammatory bowel disease, a single non-Hodgkin's lymphoma occurred in a patient with Crohn's disease. No cases were seen with ulcerative colitis. The estimated relative risk of lymphoma was 2.4 in Crohn's disease (95% confidence interval, 0.1-13), 0 in ulcerative colitis (0-6), and 1.0 in inflammatory bowel disease overall (0.03-6). Between 1976 and June 1997, 61 patients with inflammatory bowel disease and lymphoma (approximately 0.41%) were seen in the referral practice. In four patients with Crohn's disease (13%), potential neoplastic risk factors were identified - therapeutic radiation in 1, and use of purine analogs in 3 (median length of use, 11 months). CONCLUSIONS: Our population-based cohort study demonstrated that the absolute risk of non-Hodgkin's lymphoma remains quite small (0.01% per person-year). This risk may not exceed that in the general population. In our referral practice, immune modifier therapy could be potentially implicated in only 5% of cases of lymphoma occurring in the setting of inflammatory bowel disease. (C) 2000 by Am. Coll. of Gastroenterology.

Original languageEnglish (US)
Pages (from-to)2308-2312
Number of pages5
JournalAmerican Journal of Gastroenterology
Volume95
Issue number9
DOIs
StatePublished - 2000

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Inflammatory Bowel Diseases
Lymphoma
Non-Hodgkin's Lymphoma
Crohn Disease
Referral and Consultation
Ulcerative Colitis
Population
Incidence
Gastroenterology
Cohort Studies
Therapeutics
Confidence Intervals
Radiation

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Risk of lymphoma in inflammatory bowel disease. / Loftus, Jr, Edward Vincent; Tremaine, William J.; Habermann, Thomas Matthew; Harmsen, W. Scott; Zinsmeister, Alan R.; Sandborn, William J.

In: American Journal of Gastroenterology, Vol. 95, No. 9, 2000, p. 2308-2312.

Research output: Contribution to journalArticle

Loftus, Jr, Edward Vincent ; Tremaine, William J. ; Habermann, Thomas Matthew ; Harmsen, W. Scott ; Zinsmeister, Alan R. ; Sandborn, William J. / Risk of lymphoma in inflammatory bowel disease. In: American Journal of Gastroenterology. 2000 ; Vol. 95, No. 9. pp. 2308-2312.
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abstract = "OBJECTIVE: Inflammatory bowel disease with a subsequent diagnosis of non-Hodgkin's lymphoma has been reported. There is concern that the risk of developing lymphoma will rise with increasing use of immune modifier therapy. We determined the risk of non-Hodgkin's lymphoma in an U.S. population-based inception cohort, and evaluated the association between inflammatory bowel disease and lymphoma in our referral practice. METHODS: The records of all incidence cases of inflammatory bowel disease in Olmsted County, Minnesota, between 1950 and 1993 were reviewed for the diagnosis of lymphoma. Standardized incidence ratios (observed/expected) were used to estimate relative risk. In addition, the clinical features and outcomes of all patients with inflammatory bowel disease and lymphoma seen at Mayo Clinic between 1976 and 1997 were reviewed. RESULTS: Among 454 county residents diagnosed with inflammatory bowel disease, a single non-Hodgkin's lymphoma occurred in a patient with Crohn's disease. No cases were seen with ulcerative colitis. The estimated relative risk of lymphoma was 2.4 in Crohn's disease (95{\%} confidence interval, 0.1-13), 0 in ulcerative colitis (0-6), and 1.0 in inflammatory bowel disease overall (0.03-6). Between 1976 and June 1997, 61 patients with inflammatory bowel disease and lymphoma (approximately 0.41{\%}) were seen in the referral practice. In four patients with Crohn's disease (13{\%}), potential neoplastic risk factors were identified - therapeutic radiation in 1, and use of purine analogs in 3 (median length of use, 11 months). CONCLUSIONS: Our population-based cohort study demonstrated that the absolute risk of non-Hodgkin's lymphoma remains quite small (0.01{\%} per person-year). This risk may not exceed that in the general population. In our referral practice, immune modifier therapy could be potentially implicated in only 5{\%} of cases of lymphoma occurring in the setting of inflammatory bowel disease. (C) 2000 by Am. Coll. of Gastroenterology.",
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AB - OBJECTIVE: Inflammatory bowel disease with a subsequent diagnosis of non-Hodgkin's lymphoma has been reported. There is concern that the risk of developing lymphoma will rise with increasing use of immune modifier therapy. We determined the risk of non-Hodgkin's lymphoma in an U.S. population-based inception cohort, and evaluated the association between inflammatory bowel disease and lymphoma in our referral practice. METHODS: The records of all incidence cases of inflammatory bowel disease in Olmsted County, Minnesota, between 1950 and 1993 were reviewed for the diagnosis of lymphoma. Standardized incidence ratios (observed/expected) were used to estimate relative risk. In addition, the clinical features and outcomes of all patients with inflammatory bowel disease and lymphoma seen at Mayo Clinic between 1976 and 1997 were reviewed. RESULTS: Among 454 county residents diagnosed with inflammatory bowel disease, a single non-Hodgkin's lymphoma occurred in a patient with Crohn's disease. No cases were seen with ulcerative colitis. The estimated relative risk of lymphoma was 2.4 in Crohn's disease (95% confidence interval, 0.1-13), 0 in ulcerative colitis (0-6), and 1.0 in inflammatory bowel disease overall (0.03-6). Between 1976 and June 1997, 61 patients with inflammatory bowel disease and lymphoma (approximately 0.41%) were seen in the referral practice. In four patients with Crohn's disease (13%), potential neoplastic risk factors were identified - therapeutic radiation in 1, and use of purine analogs in 3 (median length of use, 11 months). CONCLUSIONS: Our population-based cohort study demonstrated that the absolute risk of non-Hodgkin's lymphoma remains quite small (0.01% per person-year). This risk may not exceed that in the general population. In our referral practice, immune modifier therapy could be potentially implicated in only 5% of cases of lymphoma occurring in the setting of inflammatory bowel disease. (C) 2000 by Am. Coll. of Gastroenterology.

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