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Recent data in adults suggest that thiopurines are associated with a threefold to fourfold increased risk for lymphoma when used to treat inflammatory bowel disease (IBD) and an increased risk for nonmelanoma skin cancers. Tumor necrosis factor (TNF) blockers without concomitant immunomodulators may not increase the risk for any cancer.
In a manufacturer-sponsored prospective study of long-term outcomes in pediatric patients receiving infliximab and/or other drugs for IBD, 5766 patients (median age, 13 years) were followed for approximately 9 years, yielding 24,543 patient-years of follow-up. Endpoints were cancer and hemophagocytic lymphohistiocytosis (HLH), a disorder associated with immune hyperstimulation and dysregulation that can be fa…