Long-term exposure to monoclonal anti-TNF is associated with an
increased risk of lymphoma in BAFF-transgenic mice
Abstract
The impact of treatment on the risk of lymphoma in patients with
rheumatoid arthritis (RA) is unclear. Here, we aimed to assess if the
risk of lymphoma differs according to the type of Tumor Necrosis factor
inhibitor (TNFi), comparing monoclonal anti-TNF antibodies (Ab) to the
soluble TNF receptor. We used BAFF-transgenic (Tg) mice as a model of
autoimmunity-associated lymphoma. Six-month aged BAFF-Tg mice were
treated with TNFi for 12 months. Histological examination of the spleen,
assessment of the cellular composition of the spleen by flow cytometry
and assessment of B cell clonality were performed at sacrifice. Crude
mortality and incidence of lymphoma were significantly higher in mice
treated with monoclonal anti-TNF Ab compared to both controls and mice
treated with the soluble TNF receptor, even at high dose. Flow cytometry
analysis revealed decreased splenic macrophage infiltration in mice
treated with monoclonal anti-TNF Ab. Overall, this study demonstrates,
for the first time, that a very prolonged treatment with monoclonal
anti-TNF Ab increase the risk of lymphoma in B cell-driven autoimmunity.
This data suggests a closer monitoring for lymphoma development in
patients suffering from B cell-driven autoimmune disease with long-term
exposure to monoclonal anti-TNF Ab.