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Lymphland International Lymphedema Online
Tumor Necrosis Factor (TNF) blockers, Azathioprine and/or Mercaptopurine: Update on Reports of
Hepatosplenic T-Cell Lymphoma in Adolescents and Young Adults
November 4, 2011 [UPDATED 11/04/2011] Healthcare professionals should remain vigilant for cases
of malignancy in patients treated with TNF blockers, and report such cases to MedWatch. The reports
should include:
patient characteristics (age, gender, no patient identifiers)
risk factors for malignancy
exposure to other immune suppressing products or products with risk of malignancy
indication for TNF blocker treatment
TNF blocker exposure (duration, dose)
cancer diagnosis (date of diagnosis, stage)
biopsy results
outcomes of malignancy (treatments, event outcome)
[Posted 04/14/2011]
ISSUE: FDA continues to receive reports of a rare cancer of white blood cells (known as Hepatosplenic
T-Cell Lymphoma or HSTCL, primarily in adolescents and young adults being treated for Crohn's disease
and ulcerative colitis with medicines known as tumor necrosis factors (TNF) blockers, as well as with
azathioprine, and/or mercaptopurine. TNF blockers include Remicade (infliximab), Enbrel (etanercept),
Humira (adalimumab), Cimzia (certolizumab pegol) and Simponi (golimumab).
BACKGROUND: HSTCL is an aggressive (fast-growing) cancer and is usually fatal. The majority of cases
reported were in patients being treated for Crohn's disease or ulcerative colitis, but also included a patient
being treated for psoriasis and two patients being treated for rheumatoid arthritis. FDA is now updating the
number of reported cases of HSTCL.
Although most reported cases of HSTCL occurred in patients treated with a combination of medicines
known to suppress the immune system, including the TNF blockers, azathioprine, and/or mercaptopurine,
there have been cases reported in patients receiving azathioprine or mercaptopurine alone.
RECOMMENDATIONS:
Educate patients and caregivers about the signs and symptoms of malignancies such as HSTCL so that they
are aware of and can seek evaluation and treatment of any signs or symptoms. These may include
splenomegaly, hepatomegaly, abdominal pain, persistent fever, night sweats, and weight loss.
Monitor for the emergence of malignancies when a patient has been treated with TNF blockers,
azathioprine, and/or mercaptopurine.
Know that people with rheumatoid arthritis, Crohn's disease, ankylosing spondylitis, psoriatic arthritis and
plaque psoriasis may be more likely to develop lymphoma than the general U.S. population. Therefore, it
may be difficult to measure the added risk of TNF blockers, azathioprine, and/or meracaptopurine.
Read the Drug Safety Communications for other specific recommendations for Healthcare Professionals and
Patients and the Data Summary for additional information.
Healthcare professionals and patients are encouraged to report adverse events or side effects related to the
use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:
Complete and submit the report Online: www.fda.gov/MedWatch/report.htm
Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the
address on the pre-addressed form, or submit by fax to 1-800-FDA-0178
[11/03/2011 - Drug Safety Communication - FDA]
[04/14/2011 - Drug Safety Communication - FDA]
Hepatosplenic T-Cell Lymphoma in Adolescents and Young Adults
November 4, 2011 [UPDATED 11/04/2011] Healthcare professionals should remain vigilant for cases
of malignancy in patients treated with TNF blockers, and report such cases to MedWatch. The reports
should include:
patient characteristics (age, gender, no patient identifiers)
risk factors for malignancy
exposure to other immune suppressing products or products with risk of malignancy
indication for TNF blocker treatment
TNF blocker exposure (duration, dose)
cancer diagnosis (date of diagnosis, stage)
biopsy results
outcomes of malignancy (treatments, event outcome)
[Posted 04/14/2011]
ISSUE: FDA continues to receive reports of a rare cancer of white blood cells (known as Hepatosplenic
T-Cell Lymphoma or HSTCL, primarily in adolescents and young adults being treated for Crohn's disease
and ulcerative colitis with medicines known as tumor necrosis factors (TNF) blockers, as well as with
azathioprine, and/or mercaptopurine. TNF blockers include Remicade (infliximab), Enbrel (etanercept),
Humira (adalimumab), Cimzia (certolizumab pegol) and Simponi (golimumab).
BACKGROUND: HSTCL is an aggressive (fast-growing) cancer and is usually fatal. The majority of cases
reported were in patients being treated for Crohn's disease or ulcerative colitis, but also included a patient
being treated for psoriasis and two patients being treated for rheumatoid arthritis. FDA is now updating the
number of reported cases of HSTCL.
Although most reported cases of HSTCL occurred in patients treated with a combination of medicines
known to suppress the immune system, including the TNF blockers, azathioprine, and/or mercaptopurine,
there have been cases reported in patients receiving azathioprine or mercaptopurine alone.
RECOMMENDATIONS:
Educate patients and caregivers about the signs and symptoms of malignancies such as HSTCL so that they
are aware of and can seek evaluation and treatment of any signs or symptoms. These may include
splenomegaly, hepatomegaly, abdominal pain, persistent fever, night sweats, and weight loss.
Monitor for the emergence of malignancies when a patient has been treated with TNF blockers,
azathioprine, and/or mercaptopurine.
Know that people with rheumatoid arthritis, Crohn's disease, ankylosing spondylitis, psoriatic arthritis and
plaque psoriasis may be more likely to develop lymphoma than the general U.S. population. Therefore, it
may be difficult to measure the added risk of TNF blockers, azathioprine, and/or meracaptopurine.
Read the Drug Safety Communications for other specific recommendations for Healthcare Professionals and
Patients and the Data Summary for additional information.
Healthcare professionals and patients are encouraged to report adverse events or side effects related to the
use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:
Complete and submit the report Online: www.fda.gov/MedWatch/report.htm
Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the
address on the pre-addressed form, or submit by fax to 1-800-FDA-0178
[11/03/2011 - Drug Safety Communication - FDA]
[04/14/2011 - Drug Safety Communication - FDA]