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Chronic anti-TNF biologic exposure ≥3 years in pediatric, adolescent, or young-adult infl...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

IDRF-IATROGENIC-ANTI-TNF-LYMPHOMA-PREVENTION
TypeRed flag
Statusreviewed 2026-05-18 | pending_clinical_signoff
DiseasesDIS-DLBCL-NOS DIS-HSTCL
SourcesSRC-NCCN-BCELL-2025 SRC-NCCN-SKIN-2025

Red Flag Origin

DefinitionChronic 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...
Clinical directioninvestigate
Categoryother

Trigger Logic

{
  "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.

Used By

Indications