The Complex Relationship between Mechanisms Underlying Inflammatory Bowel Disease, Its Treatment, and the Risk of Lymphomas: A Comprehensive Review

Sep 22, 2026

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Patients with inflammatory bowel disease may face an elevated risk of lymphomas and other gastrointestinal malignancies. Evidence also suggests a connection between thiopurines and anti–tumor necrosis factor (anti-TNF) therapies and the development of these cancers. Managing Crohn’s disease patients who have active lymphoma, or a lymphoma treatment/hematologic cancer history, remains a major clinical challenge. This review synthesizes available IBD treatments and considers how chronic inflammation, viral infections, and therapy-related immunologic effects may converge on lymphoproliferative disorders and autoimmune disease pathways, highlighting the need to quantify relative lymphoma risk and the difficulty created by limited guidance.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

Abstract

1. Introduction

2. Cancer in Inflammatory Bowel Disease

Review The Complex Relationship between Mechanisms Underlying Inflammatory Bowel Disease, Its Treatment, and the Risk of Lymphomas: A Comprehensive Review Katarzyna Stasik 1 and Rafał Filip 2, * Citation: Stasik, K.; Filip, R. The Complex Relationship between Mechanisms Underlying Inflammatory Bowel Disease, Its Treatment, and the Risk of Lymphomas: A Comprehensive Review. Int. J. Mol. Sci. 2024, 25, 4241 . [https://doi.org/10.3390/](https://doi.org/10.3390/)[ ](https://doi.org/10.3390/)ijms25084241 Academic Editors: Takuji Tanaka and Pavel Strnad Received: 25 February 2024 Revised: 6 April 2024 Accepted: 8 April 2024 Published: 11 April 2024 Copyright: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) . 1 Department of Gastroenterology with IBD Unit, Clinical Hospital No. 2, 35-301 Rzeszow, Poland; [kstasik@ur.edu.pl](kstasik@ur.edu.pl) 2 Faculty of Medicine, University of Rzeszow, 35-959 Rzeszow, Poland * [Correspondence: r.s.filip@wp.pl](Correspondence: r.s.filip@wp.pl) Abstract: Patients with inflammatory bowel disease may be at higher risk of developing lymphomasand other cancers of the gastrointestinal tract. In addition, there may be a link between the use ofthiopurines or anti-tumor necrosis factor drugs (anti-TNF) and these pathologies. The treatment of patients with Crohn’s disease who have previously been diagnosed with lymphoma is a challenge for gastroenterologists. In this report, we examine important clinical issues related to the treatment of patients with inflammatory bowel disease with active lymphoma, as well as of patients with hematological cancer history. In this discussion, we take into account most of the available treatments for inflammatory bowel disease, as well as the impact of chronic inflammation and viral infections. In addition, we try to find common ground for the development of lymphoproliferative disorders and autoimmune diseases. Patients with inflammatory bowel disease may be at higher risk of developing lymphomas and other cancers of the gastrointestinal tract. Chronic inflammatory processes and viral infections play an important role in carcinogenesis. In addition, there may be a link between the use of thiopurines or anti-TNF drugs and these pathologies. A significant risk of the development of lymphoma in people undergoing each therapy should be considered, and it should be estimated how much greater this risk will be in patients with a history of lymphoproliferative disorders. The following review is an attempt to answer which therapy would be the most appropriate for patients with Crohn’s disease and a history of lymphoma treatment. A lack of clear guidelines creates great challenges for doctors. Keywords: Crohn’s disease; inflammatory bowel disease; lymphoma; Hodgkin lymphoma 1. Introduction Inflammatory bowel disease (IBD), with two subtypes, i.e., Crohn’s disease (CD) and ulcerative colitis (UC), is characterized by chronic IBD. The etiology of these conditions involves interactions between the environment, the immune system, the gut microbiome, and a genetic predisposition to disease [1,2] . UC is a disease with relapses and remissions, and the incidence in the population continues to rise. It is characterized by mucosal inflammation that begins distally and can extend proximally, involving the entire colon. It manifests with bloody diarrhea, abdominal pain, fatigue, and fecal incontinence [2] . CD as opposed to UC is a transmural granulomatous inflammation. Lesions can involve any part of the gastrointestinal tract from the mouth to the rectum. The course of the disease is often complicated by abscesses, intestinal fistulas, intestinal–cutaneous fistulas,

FAQs

Why do patients with inflammatory bowel disease have a higher risk of lymphomas and other cancers?

Chronic inflammation associated with IBD and immune-system dysregulation can contribute to carcinogenesis. The review also discusses the role of viral infections and therapy-related immune effects.

What therapies are discussed in relation to lymphoma risk in IBD?

The review examines thiopurines and anti–tumor necrosis factor (anti-TNF) drugs. It emphasizes that each therapy may carry a significant lymphoma risk and that risk may be larger in patients with prior lymphoproliferative disorders.

How is lymphoma management described for Crohn’s disease patients with a history of lymphoma treatment?

Treating Crohn’s disease patients previously diagnosed with lymphoma is described as a significant challenge. A lack of clear guidelines creates difficulties for clinicians when selecting the most appropriate therapy.

Sep 22, 2026

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