Examples of immunomodulator agents include:
(1) adalimumab (Humira)
(2) anakira (Kineret)
(3) daclizumab (Zenapax)
(4) efalizumab (Raptiva)
(5) etanercept (Enbrel)
(6) infliximab (Remicade)
Lymphoproliferative disorders that may arise include:
(1) atypical lymphoproliferation
(2) malignant non-Hodgkin's lymphoma of either B or T cells
(3) Hodgkin's disease
Factors to investigate in each patient:
(1) other medications that may be associated with lymphoproliferative disorders such as methotrexate or 6-mercaptopurine
(2) the underlying disease being treated (which may be associated with an increased risk for lymphoma)
(3) evidence of Epstein Barr virus (EBV)
(4) clonality of the lymphocytes (polyclonal vs monoclonal)
(5) time interval between starting the medication and appearance of the lymphoproliferative disorder (temporal association)
(6) course (reversibility on drug discontinuation or progression)
Observations:
(1) EBV positivity is associated with B-cell malignant lymphoma and Hodgkin's disease.
(2) Polyclonal lymphoid proliferations are more likely to be reversible on drug discontinuation than ones that are monoclonal.
(3) Appearance of the lymphoproliferative disorder can occur within a few weeks of starting immunomodulator agent therapy but usually takes a longer period.
