653 A Multi-Center Case Series: Lymphomas in Inflammatory Bowel Disease Patients

Samir Husami; Alexa Andre; Jasmine Wang; Kwun Wah Wen; Dustin Bosch; Dipti Karamchandani; Yongjun Liu; Deepti Reddi

doi:10.1016/j.labinv.2025.104940

Background Lymphomas arising in immune deficiency/dysregulation (IDD) setting, including autoimmune/therapy-related have been documented. The association between inflammatory bowel disease (IBD) and IDD-lymphomas in adults is not well studied. Here we report IBD patients who progressed to lymphoma from 4 tertiary care academic centers across different geographic regions. Design Electronic databases from four tertiary care centers were searched for IBD and lymphoproliferative disorder between 2000 and 2025. Medical records, including pathology reports, were reviewed. Crohn disease (CD) and ulcerative colitis (UC) with lymphoproliferative neoplasms and lymphoma were included in this study. Results Twenty-one patients (female: 4, male:17) with a mean age of 63.2 years (range 32-82) were identified. Nine UC patients (female: 2, male: 7) with mean age of 72.1 years (range 42-82). Twelve CD patients (female: 2, male: 10) with mean age of 56.67 years (range 32-75). Thirteen patients were on multidrug regimen, one patient on mesalamine, one patient on adalimumab, and one patient underwent surgery. Thirteen (7 CD and 6 UC) patients developed high-grade lymphomas. Eight (5 CD and 3 UC) patients developed low-grade lymphomas. For 18 patients, overall median interval from IBD diagnosis to lymphoma was 16.8 years (16.8 years- CD; 16.87 years in UC ). Complex cytogenetics were noted in a patient with classic Hodgkin lymphoma (CHL), with enemas, Azathioprine and adalimumab therapy. For 16 patients, the average follow up were 51.8 months (range of 1-168), 8 patients died (UC:4, CD:4) and 11 patients are alive. Conclusions In the adult IBD patient population, there is male predominance in those who progress to high grade lymphoma. Patients who received azathioprine not only developed hepatosplenic T-cell (HSTL) and diffuse large B-cell lymphomas (DLBCL), which are known therapy-related complications, but also developed CHL, mucosa-associated lymphoid tissue (MALT) lymphoma and monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL). In our patient cohort, majority of the elderly, over age 65, UC patients diagnosed with high grade lymphoma had an aggressive disease course with poor prognosis, and died within one year of diagnosis.

653 A Multi-Center Case Series: Lymphomas in Inflammatory Bowel Disease Patients

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