To the Editor:
Anti-tumor necrosis factor (TNF) agents are widely used in the treatment of rheumatoid arthritis (RA). Some randomized controlled trials and a metaanalysis have raised the possibility of an increased occurrence of cancer associated with anti-TNF therapy1. In the context of hematological malignancies, there are reports of myeloma, as well as monoclonal gammopathy of undetermined significance (MGUS), progressing while receiving anti-TNF treatment2. The British Society for Rheumatology states that there is no conclusive evidence for an increase in risk of solid tumors or lymphoproliferative disease with anti-TNF therapies above what would be expected for the rest of the RA population3. Further, several studies have reported anti-TNF working against solid cancers4,5. We report a case of marginal zone lymphoma (MZL) that appeared to respond to sequential anti-TNF therapy with infliximab (IFX) and etanercept (ETN) in a patient with RA.
A 55-year-old woman was diagnosed with RA in 1991 and was noted to have a lymphocytosis (white cell count 20 × 109/l) when being considered for IFX therapy in September 2002. This was confirmed as an MZL following …
Address correspondence to Dr. S.L. Donaldson, 25 Oakdale Glen, Harrogate, HG1 2JY, North Yorkshire, UK. E-mail: s.donaldson{at}doctors.org.uk