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Monika Fischer, Debra J. Helper, Michael V. Chiorean, Myeloproliferative disorders in patients with inflammatory bowel disease on anti-TNF-α therapy: Report of two cases and review of the literature, Inflammatory Bowel Diseases, Volume 17, Issue 2, 1 February 2011, Pages 674–675, https://doi.org/10.1002/ibd.21291
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To the Editor:
A link between antitumor necrosis factor alpha (TNF-α) therapy and myeloproliferative disorders (MPD) in patients with inflammatory bowel disease (IBD) has not been established. Here we report two cases of MPD in patients with Crohn's disease (CD) from an institution-based IBD database. Of the 504 patients with IBD who have received anti-TNF-α therapy over the last 10 years we identified two patients who developed MPD.
The first case is a 32-year-old white male with an 18-year history of ileocolonic CD in remission on combination therapy with infliximab and azathioprine who discontinued both drugs for personal reasons. When infliximab was restarted 5 months later he developed fever and malaise following his second infusion. He was diagnosed with acute myeloid leukemia (AML) M4 subtype with chromosome 16 inversion. He underwent successful induction and consolidation chemotherapy. After being in remission from AML for 12 months, adalimumab was started for active CD. Three months later the patient was diagnosed with recurrence of AML (M4 subtype). He underwent allogenic peripheral stem-cell transplantation. His course was complicated with graft-versus-host disease, seizures, mesenteric ischemia, disseminated herpes simplex infection, and cardiac arrest. He died of complications from AML 6 months after the bone marrow transplantation.
