Yerigeri K, Buhtoiarov I. Pediatric-type follicular lymphoma in a Crohn’s disease patient receiving anti-α4β7-integrin therapy: A case report. World J Gastroenterol 2023; 29(43): 5865-5871 [PMID: 38074918 DOI: 10.3748/wjg.v29.i43.5865]
Corresponding Author of This Article
Keval Yerigeri, MD, Doctor, Internal Medicine-Pediatrics, Case Western Reserve University/MetroHealth, 2500 Metrohealth Dr, Cleveland, OH 44109, United States. kyerigeri@metrohealth.org
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Nov 21, 2023; 29(43): 5865-5871 Published online Nov 21, 2023. doi: 10.3748/wjg.v29.i43.5865
Pediatric-type follicular lymphoma in a Crohn’s disease patient receiving anti-α4β7-integrin therapy: A case report
Keval Yerigeri, Ilia Buhtoiarov
Keval Yerigeri, Internal Medicine-Pediatrics, Case Western Reserve University/MetroHealth, Cleveland, OH 44109, United States
Ilia Buhtoiarov, Pediatric Hematology/Oncology and Bone Marrow Transplantation, Cleveland Clinic Children’s, Cleveland, OH 44106, United States
Author contributions: Buhtoiarov I was the patient’s primary oncology attending, he provided the patient charts with informed consent, prepared images and tables for submission, and edited the manuscript; Yerigeri K prepared initial manuscript drafts and managed the submission and revisions.
Informed consent statement: Informed consent for immunotherapy as per the R-CVP protocol was obtained by Dr. Ilia Buhtoiarov and the Cleveland Clinic Children’s PHO team.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Keval Yerigeri, MD, Doctor, Internal Medicine-Pediatrics, Case Western Reserve University/MetroHealth, 2500 Metrohealth Dr, Cleveland, OH 44109, United States. kyerigeri@metrohealth.org
Received: August 1, 2023 Peer-review started: August 1, 2023 First decision: September 28, 2023 Revised: October 15, 2023 Accepted: November 9, 2023 Article in press: November 9, 2023 Published online: November 21, 2023 Processing time: 102 Days and 16.5 Hours
Abstract
BACKGROUND
Patients with autoimmune conditions receiving immunosuppressants are at risk of non-Hodgkin lymphomas (NHL). Vedolizumab (anti-α4β7-integrin antibody), a treatment-of-choice for Crohn’s disease (CD), reduces inflammatory lymphocyte trafficking into the intestinal mucosa. This effect is believed to be confined to the colon.
CASE SUMMARY
We report the case of a CD patient on vedolizumab for five years who developed pediatric-type follicular lymphoma. Work-up prior to therapy revealed a reduction in circulating T-lymphocytes and their suppressed response to mitogens. Rituximab, cyclophosphamide, vincristine, and prednisone chemo-immunotherapy resulted in durable lymphoma remission, and vedolizumab treatment was continued. While the patient’s T-lymphocyte population and immunoglobulin production recovered, the T-lymphocyte mitogen response remained suppressed.
CONCLUSION
This patient’s NHL may be linked to receiving anti-α4β7 therapy. Further research could be beneficial to determine if proactive surveillance for NHL and other systemic diseases is indicated in patients on vedolizumab.
Core Tip: The literature is inconclusive on the association between anti-α4β7-integrin therapy and oncogenesis. This case report highlights a young adult on chronic vedolizumab, a monoclonal antibody targeting α4β7-integrin, who develops pediatric-type follicular lymphoma. The patient recovered with rituximab, cyclophosphamide, vincristine, prednisone immunotherapy, but T-lymphocyte mitogen response remained suppressed.
