Published online Nov 21, 2023. doi: 10.3748/wjg.v29.i43.5865
Peer-review started: August 1, 2023
First decision: September 28, 2023
Revised: October 15, 2023
Accepted: November 9, 2023
Article in press: November 9, 2023
Published online: November 21, 2023
Processing time: 102 Days and 16.5 Hours
Patients with autoimmune conditions receiving immunosuppressants are at risk of non-Hodgkin lymphomas (NHL). Vedolizumab (anti-α4β7-integrin antibody), a treatment-of-choice for Crohn’s disease (CD), reduces inflammatory lymphocyte trafficking into the intestinal mucosa. This effect is believed to be confined to the colon.
We report the case of a CD patient on vedolizumab for five years who developed pediatric-type follicular lymphoma. Work-up prior to therapy revealed a reduction in circulating T-lymphocytes and their suppressed response to mitogens. Rituximab, cyclophosphamide, vincristine, and prednisone chemo-immunotherapy resulted in durable lymphoma remission, and vedolizumab treatment was continued. While the patient’s T-lymphocyte population and immunoglobulin production recovered, the T-lymphocyte mitogen response remained suppressed.
This patient’s NHL may be linked to receiving anti-α4β7 therapy. Further research could be beneficial to determine if proactive surveillance for NHL and other systemic diseases is indicated in patients on vedolizumab.
Core Tip: The literature is inconclusive on the association between anti-α4β7-integrin therapy and oncogenesis. This case report highlights a young adult on chronic vedolizumab, a monoclonal antibody targeting α4β7-integrin, who develops pediatric-type follicular lymphoma. The patient recovered with rituximab, cyclophosphamide, vincristine, prednisone immunotherapy, but T-lymphocyte mitogen response remained suppressed.