A170: Neoplasms in Pediatric Patients with Rheumatic Diseases Exposed to Biologics—A Quarternary Centre's Experience

Background/Purpose: Biologic therapies have revolutionized the management of rheumatic diseases of childhood. However, these medications are associated with adverse effects including the possible development of neoplasms. The aim of our study was to determine the rate as well as risk factors for the development of neoplasms in patients with JIA treated with biologics. Methods: We performed a retrospective review of the rheumatology biologic registry (RBR) at The Hospital for Sick Children (SickKids), Toronto, Canada, one of the largest quarternary pediatric referral centres in North America. Demographic and neoplastic data, clinical course and medication history were extracted from the RBR and clinical charts. Unless specified, data was expressed as median (IQR). The study was approved by the SickKids Ethics Review Board. Results: The cohort consisted of 357 patients with rheumatic diseases who were on one or more biologics between January 1997 and August 2013. Juvenile Idiopathic Arthritis (JIA) was the most common diagnosis [302/357 (84.5%)]. A total of 6/357 (1.68%) patients developed a neoplasm: 4 with JIA, 1 each with idiopathic uveitis and polyarteritis nodosa. (Refer to t87) Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Patient 6 Neoplasm Nasopharyngeal carcinoma 1. Tonsillar lymphoproliferative disorder (LD) in 2006 Clear cell renal carcinoma Hepatosplenic lymphoma Small blue cell sarcoma, undifferentiated Pilomatricoma 2. Renal carcinoma in 2011 Rheumatic Disease (RD) Idiopathic Uveitis Polyarteritis Nodosa Poly JIA (RF negative) Systemic JIA Oligo JIA (extended) Oligo JIA (extended) Age of onset of RD (years) 10.8 1.1 8.2 4.7 1.6 2.0 Sex Male Male Female Female Female Female DMARD(s), Cytotoxic agents MTX (4.7) MTX (1.2); MTX (6.2); MTX (3.6); MTX (7.2); CSA (3.2); (Time (years)) AZA (NA); LFN(0.2); CSA (0.9); LFN (0.2) AZA (4.3); Abbreviations: ‐Methotrexate (MTX), CYC (1.5) CSA (1.5); Tacrolimus (5.0); MTX (6.0); ‐Azathioprine (AZA), AZA (1.2); Etoposide (6 cycles over 34 days); LFN (2.8) ‐Leflunomide (LFN), SSA (0.9) Thalidomide (0.6) Cyclophosphamide (CYC), ‐Cyclosporine (CSA), ‐Sulfasalazine (SSA) ‐Not available (NA) Biologic(s) Infliximab (3.3) Infliximab (7.5) Etanercept (4.8) Etanercept (0.1); Etanercept (5.2) Infliximab (8.2); (Time (years)) Infliximab (1.7); Etanercept (1.5) Anakinra (1.9) Time to neoplasm (years) 5.3 1. 14.1 15.8 11.8 16.7 12.7 2. 18.6 Time from DMARD to neoplasm (years) 4.7 1. 6.8 17.6 11.8 8.4 12.6 2. 11.4 Time f