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Peer-reviewedCC BYFrontiers in oncology

Lymphoma-associated pancreatitis: a multicenter retrospective cohort study with a prediction model

  • Juju Feng1
  • Qiwei Wang2
  • Zhiyi Li3
  • Tianjiao Duan4
  • Aqian Zhao5
  • Yanhui Zhang5
  • Linqing Sun5
  • Yun Feng5
5 affiliations
  1. 1Department of Spleen and Stomach Disease, Yulin Traditional Chinese Medicine Hospital , , ,
  2. 2Health Science Center, Yangtze University , , ,
  3. 3Department of Hematology, The First Affiliated Hospital of Xi’an Jiao Tong University , , ,
  4. 4Department of Gastroenterology, Shaanxi Provincial People’s Hospital , , ,
  5. 5Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiao Tong University , , ,
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Abstract

Purpose: Pancreatitis in patients with hematologic malignancies, particularly lymphoma, is a challenging complication with heterogeneous etiologies. Large studies with systematic etiological classification and prognostic models are lacking.

Methods: This retrospective multicenter study (2020–2025) included patients with hematologic malignancies who developed acute pancreatitis. Etiologies were adjudicated using predefined criteria. A nomogram-based prediction model was developed with internal bootstrap validation.

Results: Among 1,705 patients, 31 (1.82%) developed pancreatitis: 19 lymphoma (61.3%), 9 leukemia (29.0%), and 3 plasma cell disorders (9.7%). In the lymphoma cohort (median age 59 years, 57.9% male), diffuse large B-cell lymphoma (47.4%) and peripheral T-cell lymphoma (PTCL) (21.1%) were most common. Etiology distribution: treatment-related (36.8%), direct pancreatic infiltration (31.6%), conventional (15.8%), multifactorial (10.5%), and infection-related (5.3%). Endoscopic ultrasound (EUS)-guided tissue acquisition had 83.3% diagnostic sensitivity for direct infiltration; positron emission tomography/computed tomography (PET-CT) showed a “tetrad sign” in 5/6 cases. Severe pancreatitis occurred in 21.1% of lymphoma-associated pancreatitis. The nomogram (incorporating time to pancreatitis ≤30 days, recent L-asparaginase (LAsp)/immune checkpoint inhibitors (ICIs) exposure, and absence of pancreatic mass) discriminated treatment-related from non-treatment-related etiologies with AUC 0.84 (95% CI 0.71–0.96). PTCL subtype (HR 3.12, 95% CI 1.28–7.61, p=0.012), multifactorial etiology (HR 2.56, 95% CI 1.02–6.42, p=0.045), and age ≥65 years (HR 2.01, 95% CI 0.95–4.25, p=0.07) predicted 1-year mortality (C-index 0.79).

Summary: Lymphoma-associated pancreatitis is rare (1.8% of hematologic malignancies). Treatment-related causes slightly outnumber direct infiltration. EUS-guided tissue acquisition and PET-CT are valuable for differential diagnosis. The nomogram may assist etiological classification and risk stratification, but prospective validation is required.

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Cite

BibTeXRIS
BibTeX
@article{feng2026lymphomaassociated,
  title = {{Lymphoma-associated pancreatitis: a multicenter retrospective cohort study with a prediction model}},
  author = {Juju Feng and Qiwei Wang and Zhiyi Li and Tianjiao Duan and Aqian Zhao and Yanhui Zhang and Linqing Sun and Yun Feng},
  journal = {Frontiers in oncology},
  year = {2026},
  month = sep,
  doi = {10.3389/fonc.2026.1853848},
  url = {https://europepmc.org/article/PMC/PMC13661464},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Lymphoma-associated pancreatitis: a multicenter retrospective cohort study with a prediction model
AU  - Juju Feng
AU  - Qiwei Wang
AU  - Zhiyi Li
AU  - Tianjiao Duan
AU  - Aqian Zhao
AU  - Yanhui Zhang
AU  - Linqing Sun
AU  - Yun Feng
PY  - 2026
DA  - 2026/09/30
JO  - Frontiers in oncology
DO  - 10.3389/fonc.2026.1853848
UR  - https://europepmc.org/article/PMC/PMC13661464
AB  - Purpose: Pancreatitis in patients with hematologic malignancies, particularly lymphoma, is a challenging complication with heterogeneous etiologies. Large studies with systematic etiological classification and prognostic models are lacking.  Methods: This retrospective multicenter study (2020–2025) included patients with hematologic malignancies who developed acute pancreatitis. Etiologies were adjudicated using predefined criteria. A nomogram-based prediction model was developed with internal bootstrap validation.  Results: Among 1,705 patients, 31 (1.82%) developed pancreatitis: 19 lymphoma (61.3%), 9 leukemia (29.0%), and 3 plasma cell disorders (9.7%). In the lymphoma cohort (median age 59 years, 57.9% male), diffuse large B-cell lymphoma (47.4%) and peripheral T-cell lymphoma (PTCL) (21.1%) were most common. Etiology distribution: treatment-related (36.8%), direct pancreatic infiltration (31.6%), conventional (15.8%), multifactorial (10.5%), and infection-related (5.3%). Endoscopic ultrasound (EUS)-guided tissue acquisition had 83.3% diagnostic sensitivity for direct infiltration; positron emission tomography/computed tomography (PET-CT) showed a “tetrad sign” in 5/6 cases. Severe pancreatitis occurred in 21.1% of lymphoma-associated pancreatitis. The nomogram (incorporating time to pancreatitis ≤30 days, recent L-asparaginase (LAsp)/immune checkpoint inhibitors (ICIs) exposure, and absence of pancreatic mass) discriminated treatment-related from non-treatment-related etiologies with AUC 0.84 (95% CI 0.71–0.96). PTCL subtype (HR 3.12, 95% CI 1.28–7.61, p=0.012), multifactorial etiology (HR 2.56, 95% CI 1.02–6.42, p=0.045), and age ≥65 years (HR 2.01, 95% CI 0.95–4.25, p=0.07) predicted 1-year mortality (C-index 0.79).  Summary: Lymphoma-associated pancreatitis is rare (1.8% of hematologic malignancies). Treatment-related causes slightly outnumber direct infiltration. EUS-guided tissue acquisition and PET-CT are valuable for differential diagnosis. The nomogram may assist etiological classification and risk stratification, but prospective validation is required.
SN  - 2234-943X
ER  -