TNF-á inhibitor etanercept and hematologic malignancies: Report of a case and review of the literature

We report here a 57-year-old man treated with etanercept for 6 months for psoriasis who developed myelodysplasia with acute myeloid leukemia. Leukemia cells had distinct karyotype associated with poor prognosis. The patient did not respond to cytosine arabinoside 100 mg/m² continuous infusion over 7 days with daunorubicin 45 mg/m² daily for 3 days. He also did not respond to salvage induction therapy with gemtuzumab (6 mg/m² on day 1 and 4 mg/m² on day 8) and intravenous continuous infusion cytosine arabinoside 200 mg/m₂. We review other cases of lymphoma and leukemia associated with tumor necrosis factor inhibitors and suggest mechanisms by which inhibition of the TNF-α family may predispose to cancer. We also suggest that all patients being considered for TNF-α treatment be screened for hematologic malignancies or premalignancies with blood counts and bone marrow aspirates/biopsies if indicated.