The United States Food and Drug Administration (FDA) has updated a warning, originally issued in April 2011, after receiving more reports of a rare cancer of white blood cells, known as Hepatosplenic T-cell Lymphoma or HSTCL. The rare cancer has mostly affected adolescents and young adults being treated for Crohn's disease or ulcerative colitis with TNF blockers (also known as tumor necrosis factor inhibitors), azathioprine, or mercaptopurine. TNF blockers, including Remicade, Enbrel, Humira, Cimzia, and Simponi, are biologic drugs which are used to treat certain types of arthritis.
HSTCL is a fast-growing cancer which is usually fatal. Not all reported cases were being treated for Crohn's disease or ulcerative colitis. One patient who developed HSTCL was being treated for psoriasis and two patients were being treated for rheumatoid arthritis. The FDA reported that most cases of HSTCL developed in patients treated with a combination of immunosuppressant drugs, including the TNF blockers or azathioprine or mercaptopurine but some cases occurred in patients treated with azathioprine or mercaptopurine alone.
There were two points emphasized by the FDA that bear repeating. First, patients should be aware of signs and symptoms associated with HSTCL, including splenomegaly (enlarged spleen), hepatomegaly (enlarged liver), abdominal pain, persistent fever, night sweats, and weight loss. Secondly, people with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, plaque psoriasis, and Crohn's disease have a suspected higher risk of developing lymphoma than the general population, therefore, it is difficult to know how much additional risk is due to the drugs.
Related Resources:
- TNF Blockers - What You Need to Know
- TNF Blocker Quiz - Test Your Knowledge
- Biologics Explained
- How to Weigh Benefits and Risks of Arthritis Treatment
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