P579 Hematologic Malignancies Among 1740 Inflammatory Bowel Disease Patients: Long term follow up Data from a Tertiary Center
A. Salihoglu1, N. Serin2, N. Esatoglu2, H. Yilmaz2, Y. Sengul2, I. Hatemi3, Y. Erzin3, A.F. Celik*3
1Istanbul University Cerrahpasa Medical Faculty, Hematology, Istanbul, Turkey, 2Istanbul University Cerrahpasa Medical Faculty, Internal Medicine, Istanbul, Turkey, 3Istanbul University Cerrahpasa Medical Faculty, Gastroenterology, Istanbul, Turkey
There is a concern that inflammatory bowel disease (IBD) and medications especially thiopurines and anti-TNF agents used in the treatment may be associated with increased risk of various hematologic malignancies (HM). We aimed to describe IBD patients (pts) who developed HM.
Patients characteristics. AML, acute myeloid leukemia; Aza, azathioprine; GIBD gastointestinal Behcet disease, MDS, myelodysplastic syndrome; MTX, methotrexate; SSZ, salazopyrin; TNF, tumor necrosis factor.
|sex||IBD||Age at diagnosis of IBD||AZA use||Other Tx||HM||Age at diagnosis||Time between IBD and HM (years)||Follow-up time (years)||Life statatus|
Retrospective review of medical records from all 1740 pts treated for IBD at a single gastroenterology clinic from 1999 to 2014 was performed. Pts with HM were further evaluated for the following parameters; parameters in the table and MCV before AZA use, MCV at the time of HM diagnosis, duration of AZA use.
A total of 6 pts (3/3, M/F) were identified with HM (5 MDS and 1 AML). Characteristics of the pts are summarized in Table. Median age at diagnosis of IBD and HM were 38.5 (18-55) and 48.5 (29-59) respectively. All of these 6 pts except one had been exposed to AZA and 4 were treated also with anti TNF. All 5 patients experienced leukopenia during AZA therapy. Median time of AZA treatment duration was 10 (6-18) months. Median time between IBD and HM was 6.5 years. At the time of IBD diagnosis MCV changed between 84-101. Only 1 patient had MCV > 100 before AZA treatment. In 4 patients MCV was ≤ 92 fl before AZA treatment.At the time of HM diagnosis 4 pts had a mean corpuscular volume (MCV) >98 fl Most of the patients (4/6) did not have active IBD at the time of HM diagnosis. Iron deficiency anemia with/without chronic diease anemia was exist in 5/6 pts.Median Hgb level was 11.7 (range:6.9-12.5)
Overall risk of myeloid malignancies may be increased in pts with IBD either as a consequence of AZA treatment(5/6)or in relation to unknown factors (1/6). Pts with leukopenia during AZA and MCV >98 fl (after exclusion of other causes) may be prone to develop HM and deserve increased awareness. Background iron deficiency may have some influence on the all values of MCV and MCV increment.