Incidence of neoplasms in patients who develop sustained leukopenia during or after treatment with 6-mercaptopurine for inflammatory bowel disease.

Abstract

BACKGROUND & AIMS:

Studies to date have not confirmed an association between neoplasms and inflammatory bowel disease (IBD) treated with 6-mercaptopurine (6-MP). We have observed the occurrence of some neoplasms in IBD patients who developed sustained leukopenia as a result of treatment with 6-MP. As a result, we sought to compare the incidence of neoplasms in patients who developed sustained leukopenia after taking 6-MP compared with patients treated with 6-MP without sustained leukopenia.

METHODS:

A database containing the medical records of more than 600 patients treated with 6-MP for IBD at 1 center between 1965 and 2002 was searched. The patients were divided into 2 groups. The study group consisted of patients who developed sustained leukopenia, defined as a white blood cell count of less than 4000 for 20 or more days. The control group patients matched those in the study group for age and sex. There were 3 matched controls for each patient in the study group.

RESULTS:

Eighteen patients developed sustained leukopenia and, of these, 4 developed neoplasms (22%)-2 leukemias, 1 non-Hodgkin's lymphoma, and 1 breast cancer. Of the 54 patients in the control group, 4 developed neoplasms (7%) (P = .10). Post hoc analysis revealed a statistically significant difference in the number of hematologic malignancies in the group with sustained leukopenia (P = .014). There was no significant difference between the 2 groups for all confounding variables examined.

CONCLUSIONS:

There was a trend toward a greater number of total malignancies in the sustained leukopenic patients. The data suggest that it is those patients who develop sustained leukopenia while taking 6-MP/azathioprine who are most at risk.

• Authors: William Disanti, Ramona O Rajapakse, Burton I Korelitz, Georgia Panagopoulos, Jason Bratcher
• Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol) Vol. 4 Issue 8 Pg. 1025-9 (Aug 2006) ISSN: 1542-3565 [Print] United States
• PMID: 16765651 (Publication Type: Journal Article)

Chemical References

• Immunosuppressive Agents
• Mercaptopurine

Topics

• Adult
• Aged
• Case-Control Studies
• Databases as Topic
• Female
• Humans
• Immunosuppressive Agents (administration & dosage, adverse effects)
• Incidence
• Inflammatory Bowel Diseases (drug therapy)
• Leukopenia (chemically induced)
• Male
• Mercaptopurine (administration & dosage, adverse effects)
• Middle Aged
• Neoplasms (etiology)
• Retrospective Studies