Inflammatory Bowel Diseases

Skip Navigation LinksHome > September 2011 - Volume 17 - Issue 9 > Risk of malignant lymphoma in patients with inflammatory bow...
Text sizing:
Inflammatory Bowel Diseases:
doi: 10.1002/ibd.21582
Original Clinical Articles

Risk of malignant lymphoma in patients with inflammatory bowel diseases: A Dutch nationwide study

Vos, A. C.W. MSc1; Bakkal, N. MSc1; Minnee, R. C. MD, PhD2; Casparie, M. K. MD3; de Jong, D. J. MD, PhD4; Dijkstra, G. MD, PhD5; Stokkers, P. MD, PhD2; van Bodegraven, A. A. MD, PhD6; Pierik, M. MD, PhD7; van der Woude, C. J. MD, PhD8; Oldenburg, B. MD, PhD9; Hommes, D. W. MD, PhD1*; for the Initiative on Crohn's and Colitis (ICC)

Collapse Box


Background:: Immune suppressant medications such as thiopurines and anti‐tumor necrosis factor agents are important for maintaining disease control in most patients with inflammatory bowel diseases (IBDs); however, their use has been associated with the development of malignant lymphoma. The purpose of this Dutch nationwide study was to estimate the relative risk of malignant lymphoma in IBD patients.

Methods:: IBD patients who developed a lymphoma between 1997 and 2004 were identified using the Dutch National Database of PALGA. Data from confirmed cases were collected from individual hospitals, including data on Epstein–Barr virus (EBV). The age‐adjusted 8‐year incidence of malignant lymphoma in the Netherlands was retrieved from the Central Bureau of Statistics.

Results:: Forty‐two hospitals were visited and 285 matches evaluated in the total cohort of 17,834 IBD patients. Forty‐four lymphomas were observed, resulting in a relative risk of 1.27 (95% confidence interval [CI]: 0.92–1.68). Only 19 of 44 patients (43%) were exposed to azathioprine/6‐mercaptopurine (AZA/6‐MP). Remarkably, 92% of patients (11/12) with EBV‐positive lymphoma used AZA/6‐MP, in contrast to only 19% patients (4/21) with EBV‐negative lymphoma, suggesting a strong relation between EBV‐positive lymphoma and thiopurine use.

Conclusions:: This nationwide study does not suggest a significant overall increased risk for lymphoma in IBD patients. A distinct correlation between EBV‐positive lymphoma and AZA/6‐MP use was observed. (Inflamm Bowel Dis 2011;)

© Crohn's & Colitis Foundation of America, Inc.

You currently do not have access to this article.

You may need to:

Note: If your society membership provides for full-access to this article, you may need to login on your society’s web site first.


Article Tools


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.