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LYMPHOMA IN INFLAMMATORY BOWEL DISEASE DURING THE BIOLOGIC ERA: A STUDY OF THE I-CARE EUROPEAN PROSPECTIVE COHORT

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LYMPHOMA IN INFLAMMATORY BOWEL DISEASE DURING THE BIOLOGIC ERA: A STUDY OF THE I-CARE EUROPEAN PROSPECTIVE COHORT

Julien Kirchgesner 1, Laure Ricard 2, Christian Maaser 3, Mette Julsgaard 4, Henit Yanai 5, Glen Doherty 6, Fernando Magro 7, Tamás Molnár 8, Hélène Rousseau 9, Filip Baert 10, Jean François Rahier 11, Laurent Beaugerie 1, Laurent Peyrin-Biroulet 12

Affiliations

1 Saint-Antoine Hospital, Paris, France

2 Saint Antoine hospital, Paris, France

3 Klinikum Lueneburg, Lueneburg, Germany

4 Aarhus University Hospital, Aarhus N, Denmark

5 RABIN Medical Center, Tel Aviv, Israel

6 St. Vincent's University Hospital, Dublin, Ireland

7 Centro Hospitalar São João, Porto, Portugal

8 University Of Szeged, Szeged, Hungary

9 University Hospital of Nancy, Nancy, France

10 Az Delta, Roeselare, Belgium

11 CHU UCL Mont-Godinne, Wavre, Belgium

12 Inserm U1256, Nancy University Hospital, Vandoeuvre-les-Nancy, France

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Abstract

Introduction

The risk of lymphoma in patients with inflammatory bowel disease (IBD) has been poorly assessed in the recent biologic era. No large-scale study has collected data on lymphoma-specific risk factors or extensive IBD disease characteristics and history. We assessed the risk of lymphoma and their characteristics in IBD compared to the general population in the European setting based on the I-CARE cohort.

Aims & Methods

The I-CARE cohort is a prospective cohort including IBD patients enrolled by 508 gastroenterologists from 15 countries between 2016 and 2019 (1). Patients provided monthly reports for up to six years including details of IBD treatment, clinical disease activity based on validated scores, colonoscopy procedures, and lymphoma diagnoses. Physicians yearly confirmed/completed patient’s information including disease status and therapies. Lymphoma diagnoses were confirmed based on pathological reports reviewed by an expert hematologist. For this analysis, patients with a previous history of lymphoma were excluded. Incidence of lymphoma in patients with IBD and expected incidence for each country, sex-, and 5-year age-specific stratum based on observed incidence from 2022 IARC estimates (2) were calculated.

Results

A total of 10 171 individuals with IBD (Crohn’s disease [CD], n=6149, 60.5%; ulcerative colitis [UC] and IBD unclassified [IBDu], n=4022, 39.5%) were included, among whom 5367 (52.8%) were females. During 31 152 person-years of follow-up, 13 patients with IBD were diagnosed with incident lymphoma, including 3 follicular, 3 Hodgkin, and 3 diffuse large B-cell lymphomas. Gastrointestinal involvement was observed at diagnosis in one follicular and one Hodgkin lymphoma. Two lymphomas were EBV positive. The overall incidence rate of lymphoma was of 0.42 cases per 1000 person-years. Patients with IBD (Standardized incidence ratio (SIR), 2.41; 95% confidence interval [95% CI] 1.28-4.12) had an increased risk of lymphoma overall (Table). Higher values of SIR were observed in patients aged less than 29 years (SIR, 5.41; 95% CI 0.61-19.55), male (SIR, 2.70; 95% CI, 1.23-5.13), and CD (SIR, 2.73; 95% CI, 1.18-5.39).

	Person-years	Reported cases	Expected cases	SIR (95% CI)	P value
IBD	31 152	13	5.40	2.41 (1.28-4.12)	0.008
UC/ IBDu	12 306	5	2.47	2.02 (0.65-4.72)	0.209
CD	18 846	8	2.93	2.73 (1.18-5.39)	0.022
Sex - Male	14 731	9	3.33	2.70 (1.23-5.13)	0.015
Sex - Female	16 421	4	2.07	1.93 (0.52-4.95)	0.309
Age - 15-29	6 217	2	0.37	5.41 (0.61-19.55)	0.112
Age - 30-44	12 726	3	1.15	2.62 (0.53-7.54)	0.227
Age - 45-59	8 908	5	1.79	2.79 (0.90-6.52)	0.072
Age - 60-74	3 050	3	1.82	1.65 (0.33-4.81)	0.546

Conclusion

In the biologic era, patients with IBD have a two-fold increased risk of lymphoma compared to the general population. Patients less than 29 years, males, and those with CD may represent a high-risk population. The determinants of this risk, including IBD disease activity and treatment exposure, are being investigated.

References

1. Peyrin-Biroulet L, Rahier JF, Kirchgesner J, Abitbol V, Shaji S, Armuzzi A, et al. Clin Gastroenterol Hepatol 2023;21(3):771-788.e10.
2. International Agency for research on Cancer. 2022 estimates of the incidence of 36 specific cancer types in 185 countries. https://gco.iarc.fr/today/en/about#about-cancer-today.

Disclosure

Julien Kirchgesner received consulting and/or speaker fees from Abbvie, Amgen, Alfasigma, Biosynex, Celltrion, Ferring, Galapagos, Janssen, Johnson & Johnson, Lilly, MSD, Takeda, Theradiag, Tillots, Pfizer, and Resilience. Christian Maaser declares consulting/speaker fees from AbbVie, Alfasigma, Biogen, Bristol Myers Squibb, Eli Lilly, Falk Foundation, Ferring, Galapagos, Gilead, Lilly, J&J, Pfizer, Samsung and Takeda. Mette Julsgaard declares consulting/speaker fees from Ferring, Takeda, MSD, Janssen, AbbVie, PharmaCosmos, Eli Lilly and Tillots Pharma. Henit Yanai declares consulting/speaker fees from Abbvie, Janssen, Pfizer, Takeda, Bristol Myers Squibb, and Eli Lilly. Glen Doherty declares consulting/speaker fees from Abbvie, Alfasigma, Celltrion, Lilly, Pfizer, and Takeda. Fernando Magro declares consulting/speaker fees from AbbVie, Arena, Biogen, Bristol Myers Squibb, Falk, Ferring, Hospira, Janssen, Laboratórios Vitoria, Pfizer, Eli Lilly, Merck Sharp & Dohme, Sandoz, Takeda, UCB and Vifo. Tamás Molnar declares consulting/speaker fees from MSD, AbbVie, Egis, Goodwill Pharma, Takeda, Pfizer, Janssen, Sandoz, MundiPharma, Phytotec, Roche, Fresenius, and Teva. Filip Baert declares consulting/speaker fees from AbbVie, Amgen, Arena Pharmaceuticals, Celgene, Ferring, Fresenius Kabi, Galapagos, Janssen, Merck, Pfizer, and Takeda. Jean-Francois Rahier declares consulting/speaker fees from Abbvie, Takeda, Hospira, Mundipharma, MSD, Pfizer, GlaxoSK, Janssen, Takeda, Galapagos, Ferring, Falk, Biogen, Amgen, Celltrion, and Lilly. Laurent Beaugerie declares consulting/speaker fees from Takeda, Janssen, Nordic Pharma, and Viatris. Laurent Peyrin-Biroulet declares consulting/speaker fees from Protagonist, Roche, Samsung, Sandoz, Sanofi, Satisfay, Takeda, Telavant, Theravance, Thermo Fischer, Tigenix, Tillots, Viatris, Vectivbio, Ventyx, Ysopia. Other authors have no conflicts of interest to disclose.
The I-CARE cohort was supported by following partners: Abbvie; Amgen; Ferring; Pfizer; Janssen; MSD; Takeda.

Event

UEG Week Barcelona 2026

Topics

IBD

Submission format

Abstract

Session

Lessons from large IBD real-world cohorts

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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	Outpatients			Inpatients
	4L PEG (N = 123)	1L PEG-ASC (N=135)	P value	4L PEG (N = 90)	1L PEG-ASC (N = 85)	P value
BBPS total	7.4 ± 1.7	7.8 ± 1.4	0.035	6.6 ± 1.7	7.1 ± 1.8	0.062
BBPS partial - right colon - transverse colon - left colon	2.4 ± 0.6 2.6 ± 0.5 2.5 ± 0.6	2.6 ± 0.5 2.7 ± 0.5 2.6 ± 0.5	0.003 0.048 0.528	2.2 ± 0.6 2.4 ± 0.6 2.2 ± 0.6	2.3 ± 0.6 2.5 ± 0.6 2.5 ± 0.7	0.251 0.497 0.016
Cleansing success	109 (88.6)	130 (96.3)	0.018	69 (76.7)	72 (84.7)	0.179
Excellent cleansing	47 (38.2)	61 (45.2)	0.257	12 (13.3)	25 (29.4)	0.009
Right colon cleansing	57 (46.3)	84 (62.2)	0.010	25 (27.8)	31 (36.5)	0.218