Can Entivio (generic name) cause abdominal lymphoma?

Entyvio (Vedolizumab) and Abdominal Lymphoma Risk

Vedolizumab (Entyvio) has not been associated with an increased risk of abdominal lymphoma based on current evidence. 1

Lymphoma Risk with IBD Medications

Thiopurines (Highest Risk)

• Thiopurines (azathioprine, 6-mercaptopurine) significantly increase lymphoma risk, particularly EBV-associated lymphomas with intestinal involvement 1
• The risk is estimated at one additional lymphoma for every 300-1400 patient-years of thiopurine treatment 1
• Primary EBV infection during thiopurine therapy poses a particular threat, with cases of fatal infectious mononucleosis-associated lymphoproliferative disorders reported 1
• Young EBV-seronegative patients are at higher risk for complications when exposed to thiopurines 1

Anti-TNF Agents (Moderate Risk)

• Anti-TNF monotherapy has conflicting data regarding lymphoma risk 1
• Combination therapy with thiopurines and anti-TNF agents carries a consistently increased risk of lymphoma, particularly in young EBV-unexposed patients 1
• Hepatosplenic T-cell lymphoma is a rare but serious concern, especially with combination therapy 1

Vedolizumab (Low Risk)

• Current evidence does not show an increased risk of malignancy in patients with IBD treated with vedolizumab 1
• Vedolizumab has a gut-selective mechanism of action that limits systemic immunosuppression, potentially explaining its favorable safety profile 1

Lymphoma Types in IBD Patients

Gastrointestinal Lymphomas

• Gastrointestinal tract is the most common site of extranodal lymphoma, with stomach accounting for 60-75% of cases 2
• Most common histological subtypes are diffuse large B-cell lymphoma (DLBCL) and marginal zone B-cell lymphoma of MALT type 2
• EBV-positive lymphomas may have a propensity for the intestinal tract in immunosuppressed patients 1

Marginal Zone Lymphomas

• Marginal zone lymphomas (MZL) include extranodal MZL (MALT lymphoma), splenic MZL, and nodal MZL 1
• Gastric MALT lymphoma is often associated with H. pylori infection and may respond to antibiotic therapy 1
• Non-gastric MALT lymphomas can occur throughout the GI tract and may have different treatment approaches 1

Monitoring and Management Recommendations

For Patients on Vedolizumab

• Routine monitoring for lymphoma is not specifically required for vedolizumab therapy alone 1
• Regular health maintenance screening is recommended as for the general IBD population 1

For Patients on Higher-Risk Medications

• Consider EBV serostatus testing before initiating thiopurines, especially in younger patients 1
• Regular monitoring with complete blood counts and clinical assessment for lymphadenopathy, hepatosplenomegaly, or unexplained symptoms 3
• Elevated LDH may be an early marker of occult lymphoma and should prompt further investigation 3

If Lymphoma is Suspected

• Comprehensive evaluation including CT imaging of neck, chest, abdomen, and pelvis 3
• Tissue sampling (lymph node biopsy, bone marrow aspirate/biopsy) if clinically indicated 3
• Management depends on lymphoma subtype and often involves immunochemotherapy regimens 3

Key Considerations for Clinical Practice

• When choosing IBD therapies, consider the risk-benefit profile regarding lymphoma risk, particularly in young EBV-seronegative patients 1
• Vedolizumab represents a lower-risk option for patients with concerns about lymphoma, especially those with prior EBV infection or lymphoproliferative disorders 1
• If lymphoma develops, reduction or discontinuation of immunosuppressive therapy may be necessary and should be discussed with both gastroenterology and oncology specialists 1, 4
• In some cases, discontinuation of immunosuppressive therapy may result in spontaneous regression of EBV-associated lymphoproliferative disease 1, 4