Acute lymphoid leukemia developing in the course of Crohn's Disease: Are there any guilty agents?

Nergiz Ekmen 1 * , Güray Can 2, Hadi Sasani 3
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1 Department of Gastroenterology, Faculty of Medicine, Gazi University, Ankara, Turkey
2 Department of Gastroenterology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
3 Department of Radiology, Faculty of Medicine, Tekirdag Namık Kemal University, Tekirdağ, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 18, Issue 3, pp. 65-67.
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Anti-tumor necrosis factor-alpha drugs (anti-TNF-α), which are monoclonal antibodies, have revolutionized the treatment of severe and refractory inflammatory bowel disease in the last two decades. However, these drugs pose a risk for the formation of hematological malignancies such as lymphoma and acute leukemia. To our knowledge, acute lymphoblastic leukemia has been reported in the literature in only two Crohn's patients with a history of anti-TNF-α therapy.
In this article, we reported a case of Philadelphia chromosome positive acute lymphoid leukemia occurring during the course of disease with a history of azathioprine and anti-TNF-α treatment with the diagnosis of Crohn's disease. In addition, we wanted to emphasize that the patient was followed up in remission for five years after allogeneic bone marrow transplantation although he did not receive treatment for Crohn's disease.


Ekmen N, Can G, Sasani H. Acute lymphoid leukemia developing in the course of Crohn's Disease: Are there any guilty agents?. J CLIN MED KAZ. 2021;18(3):65-7.


  • Feuerstein JD, Cheifetz AS. Crohn Disease: Epidemiology, Diagnosis, and Management. Mayo Clin Proc. 2017;92(7):1088-1103. doi: 10.1016/j.mayocp.2017.04.010.
  • Côté-Daigneault J, Bouin M, Lahaie R, Colombel JF, Poitras P. Biologics in inflammatory bowel disease: what are the data? United European Gastroenterol J. 2015;3(5):419-28. doi: 10.1177/2050640615590302.
  • Tracey D, Klareskog L, Sasso EH, Salfeld JG, Tak PP. Tumor necrosis factor antagonist mechanisms of action: a comprehensive review. Pharmacol Ther. 2008;117(2):244-79. doi: 10.1016/j.pharmthera.2007.10.001.
  • Plevy SE, Landers CJ, Prehn J, Carramanzana NM, Deem RL, Shealy D, et al. A role for TNF-alpha and mucosal T helper-1 cytokines in the pathogenesis of Crohn's disease. J Immunol. 1997;159(12):6276-82.
  • Askling J, Fored CM, Baecklund E, Brandt L, Backlin C, Ekbom A, et al. Haematopoietic malignancies in rheumatoid arthritis: lymphoma risk and characteristics after exposure to tumour necrosis factor antagonists. Ann Rheum Dis. 2005;64(10):1414-20. doi: 10.1136/ard.2004.033241.
  • Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55(6):749-53. doi: 10.1136/gut.2005.082909.
  • Cesarini M, Vernia P, Angelucci E. Acute lymphoid leukemia in a Crohn's disease patient during treatment with adalimumab after a prolonged treatment with azathioprine and steroids. Inflamm Bowel Dis. 2010;16(3):371-2. doi: 10.1002/ibd.21005.
  • Özdemirkiran FG, Payzin BK, Çoban E, Bayram KB, Küçükzeybek B. Acute lymphoid leukemia after anti-TNF-alpha treatment: a case report and review of the literature. Turk J Rheumatol. 2015;30: 349-52. DOI: 10.5606/ArchRheumatol.2015.5669.
  • Alcaín G, Andrade RJ, Queipo de Llano MP, Moreno MJ, García-Cortés M, Franquelo E. Acute leukemia after infliximab therapy. Am J Gastroenterol. 2003;98(11):2577. doi: 10.1111/j.1572-0241.2003.08682.x.
  • Annese V, Beaugerie L, Egan L, Biancone L, Bolling C, Brandts C, et al. ECCO. European Evidence-based Consensus: Inflammatory Bowel Disease and Malignancies. J Crohns Colitis. 2015;9(11):945-65. doi: 10.1093/ecco-jcc/jjv141.
  • Torres J, Bonovas S, Doherty G, Kucharzik T, Gisbert JP, Raine T, et al. ECCO Guidelines on Therapeutics in Crohn's Disease: Medical Treatment. J Crohns Colitis. 2020;14(1):4-22. doi: 10.1093/ecco-jcc/jjz180.
  • Oliveira MC, Elias JB, Moraes DA, Simões BP, Rodrigues M, Ribeiro AAF, et al. A review of hematopoietic stem cell transplantation for autoimmune diseases: multiple sclerosis, systemic sclerosis and Crohn's disease. Position paper of the Brazilian Society of Bone Marrow Transplantation. Hematol Transfus Cell Ther. 2021;43(1):65-86. doi: 10.1016/j.htct.2020.03.002.