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World J Gastroenterol. Dec 7, 2026; 32(45): 120646
Published online Dec 7, 2026. doi: 10.3748/wjg.120646
Published online Dec 7, 2026. doi: 10.3748/wjg.120646
Long-term lymphoma risk in thiopurine-treated inflammatory bowel disease: A 15-year propensity-matched cohort study
Manjeet K Goyal, Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110029, India
Rishi Chowdhary, Department of Medicine, MetroHealth Medical Center, Cleveland, OH 44109, United States
Megh Patel, Department of Medicine, B. J. Medical College, Ahmedabad 380016, Gujarat, India
Marc Landsman, Department of Gastroenterology, MetroHealth Medical Center, Cleveland, OH 44109, United States
Kirti Arora, Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH 44307, United States
Shivam Kalra, Department of Internal Medicine, Trident Medical Center, Charleston, SC 29405, United States
Rahul Chowdhary, Department of Internal Medicine, Cleveland Clinic Main Campus, Cleveland, OH 44106, United States
Ashita R Vuthaluru, Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi 110029, India
Sowmya Durga Subhasri Guna, Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, United States
Vishal Sharma, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
Co-first authors: Manjeet K Goyal and Rishi Chowdhary.
Author contributions: Chowdhary R and Goyal MK provided equal contributions as detailed below, meriting co-first authorship; Chowdhary R and Goyal MK conceptualized the study, designed the methodology; Chowdhary R performed the data collection; Chowdhary R, Goyal MK, Patel M, Landsman M, Kalra S, Chowdhary Ra, Vuthaluru AR, Subhasri Guna SD, and Sharma V performed the investigation; Chowdhary R and Patel M generated the visualization of data; Chowdhary R, Goyal MK, Patel M, and Landsman M contributed to writing of the original manuscript draft; Landsman M provided the study supervision and data validation; all authors performed editing of the subsequent versions of the manuscript, read and approved the final version of the manuscript.
AI contribution statement: No part of the manuscript (Abstract, Introduction, Materials and Methods, Results, Discussion, or Conclusion) was generated by AI. All scientific content was written and critically reviewed by the authors. AI tools were used solely for basic grammar correction and language refinement. No AI tools were used for data analysis or content generation. AI tools had no role in study design, data interpretation, or formulation of conclusions. No images in the manuscript were generated using AI. We confirm that all authors take full responsibility for the integrity and originality of the manuscript. For file “answering-reviewers”, I assure you I have drafted all the responses myself and no AI tool was used and rather I am the one who is totally against it.
Institutional review board statement: This study utilized de-identified TriNetX data; Institutional Review Board approval was not required.
Informed consent statement: This study utilized de-identified TriNetX data; consent was not required.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: The data that supports the findings of this study are openly available in TriNetX at https://trinetx.com.
Corresponding author: Manjeet K Goyal, MD, Doctor, Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar East, New Delhi 110029, India. manjeetgoyal@gmail.com
Received: March 6, 2026
Revised: April 7, 2026
Accepted: May 15, 2026
Published online: December 7, 2026
Processing time: 225 Days and 2 Hours
Revised: April 7, 2026
Accepted: May 15, 2026
Published online: December 7, 2026
Processing time: 225 Days and 2 Hours
Core Tip
Core Tip: Thiopurines remain central to maintenance therapy in inflammatory bowel disease (IBD), yet concerns about lymphoma risk complicate long-term use. This large, propensity-matched cohort study clarifies the temporal dynamics of malignancy risk, using 5-aminosalicylates as a safe active comparator. We demonstrate that thiopurines are not associated with increased lymphoma risk during the first three years of therapy, with risk elevation emerging only after prolonged use. These findings support a time-dependent, immune suppression-linked oncogenic mechanism and provide a rational basis for limited-duration thiopurine therapy with individualized risk stratification to maximize safety in IBD care.