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Exposition biologique chronique anti-TNF ≥ 3 ans chez les enfants, les adolescents ou les jeunes adultes...

Vue déterministe de l'entité source de la LJAM. L'autorité clinique demeure avec les ID de la source cités et l'état d'approbation de l ́examinateur.

IDRF-IATROGENIC-ANTI-TNF-LYMPHOMA-PREVENTION
TypeSignal d’alerte
Étatreviewed 2026-05-18 | pending_clinical_signoff
MaladiesDIS-DLBCL-NOS DIS-HSTCL
SourcesSRC-NCCN-BCELL-2025 SRC-NCCN-SKIN-2025

Origine du drapeau rouge

DéfinitionChronic anti-TNF biologic exposure ≥3 years in pediatric, adolescent, or young-adult inflammatory bowel disease (IBD) — infliximab, adalimumab, certolizumab pegol, golimumab. Modest lymphoma signal: most population-based analyses (e.g., DOLCE, Danish nationwide cohort) show small absolute-risk excess, dominated by NOT-additive signal with concomitant thiopurine (azathioprine / 6-MP) — the most-reported rare hepatosplenic T-cell lymphoma (HSTCL) cases occur in young male IBD patients on COMBINATION anti-TNF + thiopurine ≥1-2 years, not anti-TNF monotherapy. FDA Boxed Warning for anti-TNF + thiopurine combination in pediatric / young-adult IBD specifically calls out HSTCL risk. Anti-TNF monotherapy in adults aged ≥35: lymphoma RR approximately 1.0-1.3 vs background — within statistical noise. Pediatric / young-adult cohort is the higher-attention subset; in adults the conversation is domi...
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Logique de déclenchement

{
  "any_of": [
    {
      "finding": "anti_tnf_continuous_use_ge_3y_pediatric_young_adult_ibd",
      "value": true
    },
    {
      "finding": "anti_tnf_combination_thiopurine_pediatric_young_adult_ibd",
      "value": true
    },
    {
      "finding": "infliximab_adalimumab_continuous_use_ge_3y_age_lt_35",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Prevention-persona RedFlag for chronic anti-TNF biologic exposure ≥3y in pediatric / adolescent / young-adult IBD cohort. Engine routes to PreventionPlan recommending (1) EBV serology baseline in young adults, (2) B-symptom + lymphadenopathy awareness, (3) annual skin examination (synergistic with concomitant thiopurine + UV), (4) periodic shared-decision discussion of combination- therapy step-down where IBD activity allows (anti-TNF monotherapy has favourable cancer signal vs combination with thiopurine), (5) vaccination catch-up (HPV, HBV, influenza, pneumococcal). Severity = minor — absolute attributable risk in anti-TNF monotherapy is small; the meaningful signal is the combination- with-thiopurine HSTCL warning specifically in pediatric / young- adult cohort, addressed via combination-step-down counseling. Anchored to DIS-DLBCL-NOS + DIS-HSTCL. STUB pending two-Clinical- Co-Lead signoff per CHARTER §6.1 dev-mode.

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Indication