Azathioprine withdrawal leading to spontaneous remission of Iatrogenic Epstein-Barr virus-negative diffuse large B-cell lymphoma: A case report and literature review

Iatrogenic lymphomas can be caused by a variety of immunosuppressive agents. Methotrexate-associated lymphomas are the most prevalent, and methotrexate termination often leads to lymphoma regression. However, for many other immunosuppressants, the association with lymphomagenesis is less well established, and whether drug termination will lead to lymphoma regression remains unclear. We report a case of Epstein-Barr virus-negative diffuse large B-cell lymphoma in which azathioprine cessation led to lymphoma remission. A literature review revealed seven other cases of azathioprine-associated lymphomas in which drug cessation led to a spontaneous remission. An observational approach with azathioprine termination may be an optimal management method for cases in which chemotherapy can be deferred.