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Immunostimulatory Agent Evaluation: Lymphoid Tissue Extraction and Injection Route-Dependent Dendritic Cell Activation

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Published on: September 16, 2018

Immunomodulator agent-related lymphoproliferative disorders.

Robert P Hasserjian¹, Steve Chen, Sherrie L Perkins

¹Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA. rhasserjian@partners.org

Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc

|September 22, 2009

Summary

Immunomodulator agents, used for autoimmune diseases, can increase the risk of lymphoproliferative disorders (LPDs). This study examined 18 cases of these disorders, finding various lymphomas and atypical lymphoid proliferations linked to these therapies.

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Area of Science:

Immunology
Oncology
Pathology

Background:

Immunomodulator agents, including monoclonal antibodies and receptor antagonists, have transformed autoimmune disease therapy.
However, these agents, particularly anti-tumor necrosis factor alpha (TNFalpha) therapies, are associated with increased risks of lymphoproliferative disorders, infections, and vasculitis.

Purpose of the Study:

To evaluate the clinicopathological features of 18 cases of immunomodulator agent-related lymphoproliferative disorders (IAR-LPD).

Main Methods:

Retrospective analysis of 18 cases of IAR-LPD from multiple institutions.
Clinicopathological evaluation including lymphoma classification and assessment of atypical lymphoid proliferations.

Main Results:

The study identified 6 B-cell lymphomas, 2 T-cell lymphomas, 3 classical Hodgkin lymphomas, and 7 atypical lymphoid proliferations.
Two atypical proliferations regressed upon discontinuation of immunomodulator therapy.
Epstein-Barr virus (EBV) showed a strong association with B-cell and classical Hodgkin lymphomas.

Conclusions:

A wide spectrum of lymphoid proliferations can arise following immunomodulator agent therapy.
IAR-LPDs share features with other iatrogenic immunosuppression-associated lymphoproliferative diseases.
Further research is needed to understand the interplay between immunomodulators, other immunosuppressants, and lymphomagenesis.