mercaptopurine and Intestinal-Neoplasms

Crohn's disease (CD) is a chronic inflammatory disease that confers a higher risk of cancer than in the general population. New, large, population-based studies in the past decade show that patients with CD are at higher risk of colorectal, small bowel, melanoma, and cervical cancer. Patients who use thiopurines are at additional risk of development of lymphoma and nonmelanoma skin cancer. Preventive surveillance for cancers of the colorectum, skin, and uterine cervix is advised.

Topics: Colorectal Neoplasms; Crohn Disease; Early Detection of Cancer; Female; Humans; Immunosuppressive Agents; Intestinal Neoplasms; Intestine, Small; Lymphoma; Male; Melanoma; Mercaptopurine; Risk Factors; Skin Neoplasms; Uterine Cervical Neoplasms

Immunosuppressive agents and biological agents are widely used for therapy in patients with inflammatory bowel disease (IBD). However, these therapies may be associated with an increased risk of malignancy. There is evidence that exposure of the therapeutic agents such as thiopurine and anti-tumor necrosis factor for IBD is associated with an increased risk of lymphoproliferative disorders, skin cancers, or uterine cervical cancers. This article reviews the malignancies associated with the use of immunosuppressive agents and biological agents in IBD.

Topics: Adalimumab; Azathioprine; Biological Factors; Female; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Intestinal Neoplasms; Lymphoproliferative Disorders; Mercaptopurine; Risk Factors; Skin Neoplasms

Immunosuppressant medications for Inflammatory Bowel Disease can help with both symptoms and disease progression. However, like immunosuppressants used in transplant patients, they are now suspect of contributing to nonmelenoma skin cancer (NMSC). Presented is a case of a 57-year-old Jewish man with Crohn's Disease who was diagnosed with a total of 84 NMSCs. We hope to elucidate the risk of immunosuppressants, particularly the thiopurines, on the development of NMSC.

Topics: Adenocarcinoma; Crohn Disease; Fatal Outcome; Hawaii; Humans; Immunosuppressive Agents; Intestinal Neoplasms; Male; Mercaptopurine; Middle Aged; Skin Neoplasms; Sunlight

A rare case of primary intestinal T-cell lymphoma (ITL) of an 8-year-old boy is reported. Medium- to large-sized tumor cells were betaF1+, CD3+, CD8+. TIA-1+, but CD4-, CD5-, CD30-, CD56-, CD20-, CD79a-, TdT-, consistent with an intraepithelial lymphocyte (IEL) origin. They showed monoclonal rearrangement of the T-cell receptor gamma-chain and no evidence of EBV infection. No clinical, histologic, laboratory, or genetic evidence of celiac disease was detected. In adults, ITL is often associated with enteropathy and has a very poor outcome. Our patient remains in first remission 30 months after finishing the acute lymphoblastic leukemia protocol COALL-07-03 high risk standard.

Topics: Antineoplastic Combined Chemotherapy Protocols; Child; Cyclophosphamide; Cytarabine; Daunorubicin; Dexamethasone; Doxorubicin; Etoposide; Humans; Intestinal Neoplasms; Lymphoma, T-Cell; Male; Mercaptopurine; Methotrexate; Methylprednisolone; Neoplasm Staging; Receptors, Antigen, T-Cell, gamma-delta; Remission Induction; Thioguanine; Vincristine

Most complications of 6-mercaptopurine (6MP) used in the treatment of inflammatory bowel disease (IBD) occur early, whereas neoplasms occur late in the course. Concern persists that the risk is increased when 6MP is used. We report our experience with malignant tumors developing over 27 yr of treating IBD patients with 6MP.. A total of 591 patients with IBD treated with 6MP between 1969 and 1997 were followed or traced until present to identify all malignant tumors and blood dyscrasias that had developed to determine the type, distribution, and duration of the IBD, the dose and duration of 6MP therapy, the concurrent versus previous use of 6MP, the incidence and probable relationship of 6MP to specific neoplasms, and whether the 6MP had been effective in treatment.. A total of 550 patients (93%) fulfilled the criteria for follow-up; these included 380 with Crohn's disease (CD) and 170 with ulcerative colitis (UC). Twenty-five patients had developed neoplasms (16 of 380 CD and nine of 170 UC) (p = 0.66). In half of the cases, the goal of therapy had been achieved with 6MP. In 10 patients, the neoplasm was diagnosed while the patients were taking 6MP (40%) and in 15, many years after the 6MP had been terminated (60%). The incidence of neoplasms (25 of 550) was 2.7/1000 patient-years of follow-up. The most common neoplasms were found in the bowel (eight of 550, 1.6%; five CD, and three UC), and breast (three, 0.5%; two CD, and one UC). Non-Hodgkins lymphomas occurred in two patients with CD; one was cerebral and the other abdominal. One patient with CD developed leukemia. The duration of 6MP therapy ranged from 5 months to 22 yr, with a mean of 5 yr. The dose of 6MP ranged from a quarter of a tablet/day (12.5 mg) to 100 mg/day, with the majority in a range from 50 to 75 mg/day.. In no instance could a neoplasm be attributed to the use of 6MP. The incidence of colon cancer is not greater than that with long standing colitis. Suspicion of a relationship between 6MP and leukemia/lymphoma persists, but the incidence is low. This must be weighed against the improved quality of life due to 6MP for patients with IBD.

Topics: Abdominal Neoplasms; Adult; Aged; Aged, 80 and over; Brain Neoplasms; Breast Neoplasms; Colitis, Ulcerative; Crohn Disease; Drug Administration Schedule; Female; Follow-Up Studies; Hematologic Diseases; Humans; Immunosuppressive Agents; Incidence; Inflammatory Bowel Diseases; Intestinal Neoplasms; Leukemia; Lymphoma, Non-Hodgkin; Male; Mercaptopurine; Middle Aged; Neoplasms; Risk Factors; Time Factors

Topics: Azathioprine; Colitis, Ulcerative; Crohn Disease; Cyclosporine; Humans; Immunosuppressive Agents; Intestinal Neoplasms; Lymphoma; Mercaptopurine; Risk Factors

Topics: Antineoplastic Agents; Bone Neoplasms; Dactinomycin; Female; Floxuridine; Fluorouracil; Genital Neoplasms, Female; Humans; In Vitro Techniques; Intestinal Neoplasms; Leukemia; Mechlorethamine; Melanoma; Mercaptopurine; Methotrexate; Neoplasms; Pharyngeal Neoplasms; Respiratory Tract Neoplasms; Stomach Neoplasms; Thiotepa

Topics: Adenocarcinoma; Alkylating Agents; Animals; Antineoplastic Agents; Bence Jones Protein; Cecum; Cyclophosphamide; gamma-Globulins; Intestinal Neoplasms; Mechlorethamine; Mercaptopurine; Methotrexate; Mice; Multiple Myeloma; Neoplasms; Neoplasms, Experimental; Neoplasms, Plasma Cell; Pathology; Pharmacology; Prednisolone; Radiation Effects; Research

Topics: Adenocarcinoma; Animals; Breast; Intestinal Neoplasms; Mercaptopurine; Mice