Published online Nov 15, 2015. doi: 10.4291/wjgp.v6.i4.181
Peer-review started: March 31, 2015
First decision: April 23, 2015
Revised: June 14, 2015
Accepted: August 30, 2015
Article in press: September 28, 2015
Published online: November 15, 2015
Processing time: 52 Days and 22 Hours
Immunosuppressive agents, such as thiopurines, methotrexate, and biologics, have revolutionized the treatment of inflammatory bowel disease (IBD). However, a number of case reports, case control studies and retrospective studies over the last decade have identified a concerning link between immunosuppression and lymphoproliferative disorders (LPDs), the oncological phenomenon whereby lymphocytes divide uncontrollably. These LPDs have been associated with Epstein-Barr virus (EBV) infection in which the virus provides the impetus for malignant transformation while immunosuppression hampers the immune system’s ability to detect and clear these malignant cells. As such, the use of immunosuppressive agents may come at the cost of increased risk of developing LPD. While little is known about the LPD risk in IBD, more is known about immunosuppression in the post-transplantation setting and the development of EBV associated post-transplantation lymphoproliferative disorders (PTLD). In review of the PTLD literature, evidence is available to demonstrate that certain immune suppressants such as cyclosporine and T-lymphocyte modulators in particular are associated with an increased risk of PTLD development. As well, high doses of immunosuppressive agents and multiple immunosuppressive agent use are also linked to increased PTLD development. Here, we discuss these findings in context of IBD and what future studies can be taken to understand and reduce the risk of EBV-associated LPD development from immunosuppression use in IBD.
Core tip: Immunosuppressive agents, such as thiopurines, methotrexate, and biologics, have revolutionized the treatment and maintenance therapy of inflammatory bowel disease (IBD). However, their use may come at the cost of increased risk of developing lymphoproliferative disorders (LPD). While little is known about this risk in IBD, more is known about immunosuppression risk in the fields of rheumatoid arthritis and post-transplantation with regards to the development of Epstein-Barr virus (EBV) associated LPD. Here, we attempt to review lymphoma risk in the setting of immunosuppression use in various medical conditions, discuss what lessons may be translatable to the IBD field and what future directions can be taken to reduce the risk of EBV-associated LPD from immunosuppression use in IBD.