Patients With Inflammatory Bowel Disease Face Modest Increase in Risk of Lymphoma

According to the results of a recent systematic review and meta-analysis, there is a modest increase in the risk of developing lymphoma in patients with inflammatory bowel disease (IBD), and more prominently in patients with Crohn disease than in those with ulcerative colitis (UC).¹

The risk of developing lymphoma is modestly higher in patients with inflammatory bowel syndrome, according to a meta-analysis. | Image Credit: © Dennis | stock.adobe.com

Becoming increasingly prevalent worldwide, IBD can lead to life-threatening intestinal complications. Lymphomas are one of the most common hematologic malignancies and are commonly detected in patients with IBD who develop such a malignancy. In an analysis of almost a dozen studies of IBD characteristics, 589 lymphomas were described in patients with IBD, with primary intestinal lymphoma representing a large portion of these cases.²

Concerns have been raised about the potential risks and clinical implications of this prevalence. Evidence on the subject has often been conflicting, which has led to uncertainty in medical circles—some studies have failed to establish a significant association between IBD and lymphoma risk, whereas others have suggested such a link.¹

To provide some clarity, the current investigators sought to thoroughly examine the risk of lymphoma in patients with IBD—both CD and UC—while specifically focusing on the differentiation between non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma (HL). Overall, they aimed to enhance the understanding of the mechanisms that link IBD and lymphoma development.¹

After an extensive screening process, 23 eligible articles were included in this review. A total of 2078 lymphoma events were reported across 656,731 patients with IBD. The meta-analysis indicated that patients with IBD had 30% higher odds of developing lymphoma (RR = 1.30; 95% CI, 1.21-1.40), with no major heterogeneity observed between studies. Importantly, no significant differences between the risk of HL (9 studies, RR = 1.29; 95% CI, 1.06-1.53) and NHL (16 studies, RR = 1.31; 95% CI, 1.20-1.42) were observed.¹

Increased lymphoma risk was observed in both patients with CD (17 studies, RR = 1.54; 95% CI, 1.27-1.80) and UC (20 studies, RR = 1.22; 95% CI, 1.09-1.35), with no major differences between each group. The meta-analysis of 9 studies evaluating the sex-specific risk of developing lymphoma did not find a major difference between men with IBD (RR = 1.27; 95% CI, 1.19-1.36) and women with IBD (RR = 1.19; 95% CI, 1.08-1.29).¹

Though systematic reviews on this subject have taken place in the past, the investigators deemed this current review the first that specifically assessed lymphoma risk in patients with IBD. One recent review, conducted by Russo et al, found the incidence rate for lymphoma in IBD ranged from <1 to 89 per 100,000 person/years, with no major difference between CD and UC.³

However, in this review, a large portion of the studies included were either case-control studies or had indeterminable study types. Limitations such as these are prevalent in other systematic reviews or meta-analyses conducted regarding the topic, which has made evidence up to this point unreliable.^1,3

In their discussion, the investigators noted the importance of a greater understanding of the increased lymphoma risk in patients with IBD. This importance covers multiple areas, including being crucial for early detection, improved patient outcomes, and more effective disease management. Relevant health care providers should be aware of this modest increase in risk, and they should use this knowledge to be more vigilant in the monitoring of patients with IBD.¹

“Altogether, more data are needed in future studies including on subtypes of IBD and lymphoma location, as well as controlling uniformly all potential confounders when analyzing,” the investigators concluded.¹

REFERENCES

1. Zamani M, Alizadeh-Tabari S, Murad MH, et al. Meta-analysis: Risk of lymphoma in patients with inflammatory bowel disease in population-based cohort studies. 2024. doi:10.1111/apt.18277

2. Muller M, Broséus J, Feugier P, et al. Characteristics of lymphoma in patients with inflammatory bowel disease: A systematic review. J Crohn Colitis. 2021;15(5):827-839. doi:10.1093/ecco-jcc/jjaa193

3. Russo MF, Diddoro A, Iodice A, et al. Incidence of lymphomas in inflammatory bowel disease: Report of an emblematic case, systematic review, and meta-analysis. Front Med. 2023;10. doi:10.3389/fmed.2023.1172634