Ming V. Lin

A Systematic Review of Factors That Contribute to Hepatosplenic T-Cell Lymphoma in Patients With Inflammatory Bowel Disease

BACKGROUND & AIMS Hepatosplenic T-cell lymphoma (HSTCL) is a rare and usually fatal lymphoma that primarily affects men younger than 35 years old. Treatment of patients with inflammatory bowel disease (IBD) using antibodies to tumor necrosis factor (anti-TNFs) and thiopurines has been associated with HSTCL. We investigated the medications, duration of therapy, and ages of patients associated with HSTCL. METHODS We collected and analyzed data on the association between HSTCL, and anti-TNF and thiopurine therapies in patients with IBD from published reports and the MedWatch reporting system of the US Food and Drug Administration. RESULTS Of 36 patients with HSTCL, 20 received therapy with infliximab and a thiopurine and 16 received a thiopurine as monotherapy for IBD. Four patients who had been treated with infliximab and a thiopurine also received adalimumab. One of these patients had been given infliximab, adalimumab, and natalizumab. Of 31 patients of known gender, only 2 were female. Twenty-seven of the 30 patients of known age were younger than 35 years old. CONCLUSIONS Most patients with HSTCL who received long-term therapy (at least 2 y) with thiopurines for IBD were men younger than 35 years old. There were no reported cases of HSTCL in patients with IBD who received only anti-TNF therapy. Physicians should consider giving thiopurines and anti-TNF agents to young male patients with IBD only in cases in which a clear benefit is expected, such as in early stage disease in untreated patients or possibly in very severe cases.

T1287 Risk of Postoperative Infections in IBD Patients Treated With Perioperative Anti-TNF Therapy: A Meta-Analysis

Results: In our study cohort (mean age 60.2 ±11.8 years, 57.5 % females, 17 % current smokers, median follow up 292 days), 135 patients underwent 340 endoscopic stricture dilations (159 primary and 181 anastomotic). The median intervention-free (repeat dilation or surgery) period was 140 days and there were total of 4 complications (3 perforations, 1 major bleeding). There was no difference between primary or anastomotic strictures with respect to need for surgery (p=0.17, Figure), intervention-free period (p= 0.24) or perforation rate (0.7% versus 1.2%, p= 0.57). 36 patients (26.7%) underwent surgery in the follow-up period. Multivariate Cox regression analysis showed that inflamed mucosa (hazard ratio [HR] 2.3, p=0.04) and colonic location (HR, 2.5, p=0.03) were significantly associated with increased risk for future surgery while intramucosal steroid injection did not confer any benfit. Conclusion: In this largest experience reported so far, we have found that endoscopic dilation is very safe and effective for CD patients with anastomotic as well as non-anastomotic strictures. Future studies should aim to investigate endoscopic and pharmacologic interventions that can prolong the intervention-free period and improve longterm outcomes.

W1201 The Risk of Infectious Complications Associated With the use of Immunosuppressive Medications in Elderly Patients With Inflammatory Bowel Disease

Background: The use of immunsuppressive agents (ISA) is associated with (a/w) significant adverse events,including infectious complications (IC) in IBD pts. In the TREAT registry (CGH 2006;4:621-630) age and prednisone use in IBD pts were a/w increased mortality and IC. The use of infliximab was suggested to be a/w an increased mortality rate in elderly pts treated for IBD (Gastroenterology 2004;126:19-31). 6-MP/azathioprine was well tolerated by the elderly in an uncontrolled trial (AJG 2009;14:1171). No studies were published comparing IC a/w the different immunosuppressive medications between elderly and young. Aim: To assess if age is an independent risk factor for prediction of IC in IBD pts exposed to ISA. Methods: We searched our electronic medical records to identify pts with CD/UC aged >17 between 2007-2009. Pts with cancer, immunodeficiency and exposure to ISA for other reasons were excluded. Data on demographics, IBD subtypes, co-morbidities, medication details and infections were collected and analyzed. Results: 48 pts with IBD and age >65 yrs and 162 pts with IBD and age 17 yrs were identified. The demographics, IBD subtypes, co-morbidities (e.g. DM, CHF, CAD, CKD/CRF, cirrhosis, obesity and depression) and IC are in Table 1. The ISA exposures for both groups are in Table 2. Elderly pts were 5 times more likely to have IC compared to young pts (OR=5.07, 95% CI 1.87-13.70, p=0.0014). Pts with co-morbidities were 8 times more likely to develop infections (OR= 8.60, 95% CI 3.06-24.18, p<0.0001)than pts without co-morbidities. 5% of young pts, 10% of elderly without co-morbidities, and 30% of elderly with co-morbidities had IC (p=0.0006). In the multivariable logistic regression model for risk of IC, age and co-morbidity were the only predictors a/w significant increase of IC. Sex, race, IBD subtype, CS/IMM/Bio exposure were not significantly a/w IC when comparing the two groups. Conclusion: There is an increased risk of IC in the elderly. Age and co-existing co-morbidities are independent risk factors for prediction of IC in IBD pts exposed to ISA. Table 1