Review article: malignancy on thiopurine treatment with special reference to inflammatory bowel disease

Smith, Melissa A.; Irving, Peter M; Sanderson, Jeremy

doi:10.1111/j.1365-2036.2010.04330.x

Cited by 86 publications

(60 citation statements)

References 150 publications

(186 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, we observed that Vδ2 T cells in CD patients are highly sensitive to AZA exposure, leading to the selective ablation of these cells over about a year of continuous therapy. While impaired Vδ2 T cell function may contribute to the therapeutic effects of AZA in active CD, complete loss of this tumor surveillance population may also confer increased risk of malignancy, consistent with the increased rates of lymphoma observed in AZAtreated CD patients (41)(42)(43).…”

Section: Discussionmentioning

confidence: 65%

Azathioprine therapy selectively ablates human Vδ2+ T cells in Crohn’s disease

McCarthy¹,

Hedin²,

Sanders³

et al. 2015

J. Clin. Invest.

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 65%

Azathioprine therapy selectively ablates human Vδ2+ T cells in Crohn’s disease

McCarthy¹,

Hedin²,

Sanders³

et al. 2015

J. Clin. Invest.

View full text Add to dashboard Cite

show abstract

“…Azathioprine is preferred in some centres for patients transplanted with HCV claiming for amelioration of viral recurrence and prevention of graft loss [110] . Long term use of azathioprine increases the risk of non-melanoma skin cancer [111] and lymphoma, the later when high doses are used especially in elderly patients [112] , but there is no proved role on HCC. On the other hand mycophenolate seems to be protective against malignancy in the transplant population [113,114] but again there is no evidence supporting any significant effect on HCC.…”

Section: Strategies To Improve Outcome After Liver Transplantationmentioning

confidence: 99%

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

Guerrero-Misas

Rodríguez‐Perálvarez

Mata

2015

WJH

View full text Add to dashboard Cite

Liver transplantation is the only therapeutic option which allows to treat both, the hepatocellular carcinoma and the underlying liver disease. Indeed, liver transplantation is considered the standard of care for a subset of patients with cirrhosis and hepatocellular carcinoma.However, tumour recurrence rates are as high as 20%, and once the recurrence is established the therapeutic options are scarce and with little impact on prognosis. Strategies to minimize tumour recurrence and thus to improve outcome may be classified into 3 groups: (1) An adequate selection of candidates for liver transplantation by using the Milan criteria; (2) An optimized management within waiting list including prioritization of patients at high risk of tumour progression, and the implementation of bridging therapies, particularly when the expected length within the waiting list is longer than 6 mo; and (3) Tailored immunosuppression comprising reduced exposure to calcineurin inhibitors, particularly early after liver transplantation, and the addition of mammalian target of rapamycin inhibitors. In the present manuscript the available scientific evidence supporting these strategies is comprehensively reviewed, and future directions are provided for novel research approaches, which may contribute to the final target: to cure more patients with hepatocellular carcinoma and with an improved long term outcome. Core tip: Liver transplantation is the only therapeutic option which allows to treat both, the hepatocellular carcinoma and the underlying liver disease. However, tumour recurrence rates are 15%-20% with a very poor prognosis. Strategies to minimize tumour recurrence and thus to improve outcome are focused in a careful selection of candidates for liver transplantation, an optimized management within waiting list and a tailored immunosuppression. The available scientific evidence supporting these strategies is reviewed, and future directions are provided for novel research approaches, which may contribute to the final target: to cure more REVIEW Submit a

show abstract

“…In addition, the use of immunosuppressive drugs such as azathioprine and mercaptopurine, and monoclonal antibodies such as infliximab, could increase the risk of malignancy (8,11,12). On the other hand, thiopurines cause an increase in this risk by enhancing radiosensitivity (13). Thus, patients with a more severe disease which received higher doses of radiation (10,11) and required a more frequent use of immunosuppressive and/or biological drugs, would have an increased risk for tumor development (8).…”

Section: Discussionmentioning

confidence: 99%

Ionizing radiation in patients with Crohns disease: Estimation and associated factors

Ciáurriz-Munuce

Fraile-González

León-Brito

et al. 2012

Rev. esp. enferm. dig.

View full text Add to dashboard Cite

Introduction: exposure to ionizing radiation is associated with an increased risk of developing tumors. Patients with Crohn's disease (CD) usually require multiple imaging tests using this type of radiation.Objectives: the objectives of this study were to estimate the total dose of ionizing radiation received by patients with Crohn's disease during their course and to identify the factors associated with higher radiation doses.Methods: two hundred thirty-five CD patients diagnosed between 1972 and 2010 were included. The effective dose (ED) received by each patient was calculated retrospectively based on the number of gastrointestinal transit studies and computed tomography scans performed. Considering recent epidemiological studies, an ED greater than or equal to 50 mSv was used as the cut-off point for increased risk of developing cancer.Results: the mean ED received per patient was 33.4 mSv (95% CI 29.3-37.5). A total of 49 (20.8%) patients received an ED ≥ 50 mSv. The following factors were identified as independent predictors associated with an ED ≥ 50 mSv: Age older than 40 years, need for surgery, age under 16 years at diagnosis and disease duration over 8 years.Conclusions: a substantial proportion of patients with Crohn's disease receive high doses of potentially carcinogenic ionizing radiation. Identification of the most susceptible patients to receive high doses of radiation, monitoring of effective doses received and the use of imaging techniques that do not require ionizing radiation (MR enterography, abdominal ultrasound) could contribute in reducing patients' exposure to potentially carcinogenic ionizing radiation.

show abstract

Review article: malignancy on thiopurine treatment with special reference to inflammatory bowel disease

Abstract: SUMMARY BackgroundImmunosuppression is a risk factor for carcinogenesis. Thiopurines specifically contribute to this. As thiopurines are used more aggressively in the treatment of IBD, it is likely that we will see more thiopurine-related malignancy.

Cited by 86 publications

References 150 publications

Azathioprine therapy selectively ablates human Vδ2+ T cells in Crohn’s disease

Azathioprine therapy selectively ablates human Vδ2+ T cells in Crohn’s disease

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

Ionizing radiation in patients with Crohns disease: Estimation and associated factors

Contact Info

Product

Resources

About

Review article: malignancy on thiopurine treatment with special reference to inflammatory bowel disease

Abstract: SUMMARY BackgroundImmunosuppression is a risk factor for carcinogenesis. Thiopurines specifically contribute to this. As thiopurines are used more aggressively in the treatment of IBD, it is likely that we will see more thiopurine-related malignancy.

Cited by 86 publications

References 150 publications

Azathioprine therapy selectively ablates human Vδ2+ T cells in Crohn’s disease

Azathioprine therapy selectively ablates human Vδ2+ T cells in Crohn’s disease

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

Ionizing radiation in patients with Crohns disease: Estimation and associated factors

Contact Info

Product

Resources

About

Ionizing radiation in patients with Crohns disease: Estimation and associated factors