Non-Hodgkin Lymphoma of the Stomach in a Patient Treated With Natalizumab

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A 61-year-old man with relapsing-remitting multiple sclerosis developed diffuse large B-cell lymphoma (DLBCL) of the stomach following 6 years of monthly natalizumab infusions, according to a case report published in the journal Clinical Medicine Insight: Oncology.

Multiple sclerosis is an inflammatory demyelinating disorder of the central nervous system. One treatment for this neurological disease is natalizumab, a monoclonal antibody approved by the U.S. Food and Drug Administration (FDA) only for the treatment of patients with highly active relapsing-remitting disease and patients who do not respond to or tolerate first-line therapy. However, natalizumab has been implicated as a potential cause of primary central nervous system lymphoma.

The patient presented with fevers, weight loss, and abdominal pain. The patient had received 64 treatments of monthly natalizumab prior to his presentation.

After undergoing an upper endoscopy, immunohistochemistry tests, and a positron emission tomography (PET) scan, the patients was ultimately diagnosed with extranodal DLBCL of the stomach.

The patient remains in complete remission at 8 months following completion of 4 cycles of infusional etoposide, vincristine, doxorubicin, cyclophosphamide with prednisone, and rituximab (R-EPOCH) and consolidative radiation therapy to the involved site.

The case report suggests that a causal relationship between natalizumab treatment and extranodal DLBCL cannot be discounted in the absence of a known association between multiple sclerosis and DLBCL.

Given the absence of association between multiple sclerosis, diffuse large B-cell lymphoma, causal association with natalizumab cannot be excluded.

Abstract: A 61-year-old man with relapsing-remitting multiple sclerosis developed extranodal large B-cell lymphoma of the stomach following monthly natalizumab infusions for 6 years.

Development of lymphoproliferative disorders increases with chronic use of immunosuppression. Cases of primary central nervous system lymphoma as well as one case of peripheral T-cell lymphoma have previously been reported with natalizumab use.

Given the absence of a known association between multiple sclerosis and extranodal presentations of diffuse large B-cell lymphoma, a causal association with natalizumab administration cannot be excluded.

Keywords: natalizumab, multiple sclerosis, Non-Hodgkin lymphoma of the stomach.

Citation: Law et al. Non-Hodgkin Lymphoma of the Stomach in a Patient Treated with Natalizumab. Clinical Medicine Insights: Oncology 2015:9 61–63 doi: 10.4137/CMO.S27142.

Received: April 02, 2015. ReSubmitted: June 07, 2015. Accepted for publication: June 09, 2015.

Academic editor: William C. S. Cho, Editor in Chief

Type: Case Report

Funding: Authors disclose no funding sources.

Competing Interests: Authors disclose no potential conflicts of interest.

Correspondence: [email protected]

Copyright: ©the authors, publisher and licensee Libertas Academica Limited. This is an open-access article distributed under the terms of the Creative Commons CC-BY-NC 3.0 License.

Paper subject to independent expert blind peer review by minimum of two reviewers. All editorial decisions made by independent academic editor. Upon submission manuscript was subject to anti-plagiarism scanning. Prior to publication all authors have given signed confirmation of agreement to article publication and compliance with all applicable ethical and legal requirements, including the accuracy of author and contributor information, disclosure of competing interests and funding sources, compliance with ethical requirements relating to human and animal study participants, and compliance with any copyright requirements of third parties. This journal is a member of the Committee on Publication Ethics (COPE).

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Non-Hodgkin Lymphoma of the Stomach in a Patient Treated With Natalizumab

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