Autoimmune disease, tumor necrosis factor inhibitors and acute leukemia: Possible associations in two patients?

摘要

We have read the article by DiNardo et al, "Characteristics and outcome of acute myeloid leukemia in patients with a prior history of autoimmune disease" [1], and would like to share our experience on the subject matter. Tumor necrosis factor-oc inhibitors (anti-TNF) are commonly used in a number of inflammatory conditions such as Crohn's disease and rheumatoid arthritis. The most commonly used agents of this class are adalimumab, inflix-imab and etanercept [2]. However, these agents are associated with potentially serious side effects. The relationship between TNF inhibitors and the development of malignancy, including lymphomas and solid tumors, has been defined recently [3]. Secondary acute leukemia can develop after the onset of autoimmune diseases and the usage of some drugs and chemotherapeutic agents [4]. Ten years ago, the first leukemia after anti-TNF use was reported [5]. The Food and Drug Administration (FDA) reported the post-marketing results of TNF blockers, and there were 44 cases with acute myeloid leukemia (AML) secondary to anti-TNF [4,6].