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Lymphoma in IBD: Who’s at Highest Risk?
A cohort study based on patient registries from Sweden and Denmark found that over the past 2 decades, hazard ratios (HR) for lymphomas have increased among patients with Crohn's disease (CD), but not among patients with ulcerative colitis (UC), according to research published in Clinical Gastroenterology and Hepatology.
T-cell lymphomas and aggressive B-cell lymphomas drove the increase among patients with CD, the authors found.
The investigators noted that previous studies “rarely reflect modern-day management of IBD,” and have been limited due to detection biases—particularly during the first year of follow-up—misclassification, and small sample sizes.
“We performed a binational register-based cohort study (Sweden and Denmark) from 1969 to 2019,” the authors wrote, comparing 164,716 patients with IBD with 1,639,027 matched individuals from the general population. The team estimated HRs using Cox regression for incident lymphoma by lymphoma subtype, excluding the first year of follow-up evaluation.
“From 1969 to 2019, 258 patients with Crohn’s disease (CD), 479 patients with ulcerative colitis (UC), and 6675 matched reference individuals developed lymphoma. This corresponded to incidence rates of 35 (CD) and 34 (UC) per 100,000 person-years in IBD patients, compared with 28 and 33 per 100,000 person-years in their matched reference individuals,” the authors reported.
The study revealed that although CD and UC were associated with an increase in the risk of developing lymphoma, the cumulative difference in the incidence remained low in patients with both types of IBD.
Hazard ratios “have increased in the past 2 decades, corresponding to increasing use of immunomodulators and biologics during the same time period,” the authors wrote, and increased for aggressive B-cell non-Hodgkin lymphoma among both CD and UC patients, and for T-cell non-Hodgkin lymphoma among CD patients.
“Although the highest HRs were observed in patients exposed to combination therapy (immunomodulators and biologics) or second-line biologics, we also found increased HRs in patients naïve to such drugs,” the researchers wrote.
Reference:
Olén O, Smedby KE, Erichsen R, Sachs MC, Sørensen HT, Ludvigsson JF. Increasing risk of lymphoma over time in Crohn’s disease but not in ulcerative colitis: a Scandinavian cohort study. Clin Gastroenterol Hepatol. Published online ahead of press April 13, 2023
