1. Immunosuppressants (Azathioprine, Cyclosporine, Methotrexate)

Used for: Autoimmune conditions such as rheumatoid arthritis, Crohn’s disease, lupus, and post-transplant rejection prevention.

Immunosuppressive drugs reduce the body’s immune defenses, making it easier to control autoimmune inflammation — but also reducing immune surveillance against cancer cells.

Evidence:

Long-term use of Azathioprine (Imuran®) and Cyclosporine (Neoral®) has been linked in multiple studies to higher rates of non-Hodgkin lymphoma (NHL), particularly in organ transplant patients.

Methotrexate, widely used for rheumatoid arthritis, has also been associated with “methotrexate-associated lymphoproliferative disorder”, a reversible lymphoma-like condition that sometimes resolves when the drug is stopped.

What to do:

Doctors emphasize risk–benefit balance. For many autoimmune patients, the benefit of disease control outweighs the small increase in lymphoma risk — but routine blood monitoring is essential.

💡 Tip: Ask your physician about periodic lymph node checks or blood tests if you’ve been on these medications for more than five years.

2. TNF Inhibitors (Adalimumab, Etanercept, Infliximab)

Used for: Rheumatoid arthritis, psoriasis, ulcerative colitis, and Crohn’s disease.

TNF inhibitors — including Humira®, Enbrel®, and Remicade® — work by blocking tumor necrosis factor (TNF), a protein involved in inflammation. However, TNF also plays a role in immune defense against cancer cells.

Research Findings:

The FDA and several meta-analyses have noted a slight but measurable increase in lymphoma cases among long-term TNF inhibitor users.

The risk appears higher when combined with other immunosuppressants like methotrexate.

Younger male patients and those with autoimmune diseases affecting the gut (Crohn’s or ulcerative colitis) may have elevated susceptibility.

What experts say:

The absolute risk remains very low — about 2–3 extra lymphoma cases per 10,000 patients annually — but awareness and regular screening are key.

3. Certain Blood Pressure Medications (ARBs and ACE Inhibitors)

Used for: Hypertension, heart failure, and kidney protection in diabetes.

Recent population studies suggest that Angiotensin II Receptor Blockers (ARBs) — such as Losartan (Cozaar®) and Valsartan (Diovan®) — may have weak associations with lymphoma and other cancers, possibly due to long-term cellular effects on DNA regulation.

What research shows (2024–2025):

A large Scandinavian registry found a slightly increased risk of non-Hodgkin lymphoma in patients using ARBs for more than eight years.

However, the association was not confirmed in shorter-term studies or across all populations.

Clinical interpretation:

Experts caution against alarm. The benefits of blood pressure control — preventing heart attacks and strokes — far outweigh this uncertain risk. Still, ongoing surveillance is recommended for patients on high-dose, long-duration therapy.

4. Certain Antidepressants (Long-Term SSRI Use)

Used for: Depression, anxiety, and panic disorders.

Selective Serotonin Reuptake Inhibitors (SSRIs) such as Sertraline (Zoloft®), Fluoxetine (Prozac®), and Citalopram (Celexa®) have been among the most prescribed medications for decades.

Emerging research now suggests long-term use (over 10 years) could slightly influence immune cell activity and increase lymphoma susceptibility in rare cases.

Current evidence:

Studies remain inconclusive — some show no correlation, while others find a minor rise in lymphoma risk among chronic users.

The potential mechanism may involve immune dysregulation or oxidative stress from prolonged serotonin modulation.

What doctors recommend:

Do not discontinue antidepressants without consulting your provider. If you’ve been on SSRIs long-term, discuss possible alternatives or dosage adjustments with your psychiatrist.

Understanding Risk in Context

It’s vital to interpret these findings in perspective:

The absolute risk of developing lymphoma from any of these medications is still very low.

Genetic predisposition, autoimmune disease itself, and viral factors (like EBV) often play larger roles.

Stopping or switching medication without medical advice can be far more dangerous than the potential cancer risk.

💡 Remember: The goal is informed awareness — not fear. Work closely with your healthcare team to weigh risks, monitor regularly, and make personalized treatment decisions.

How to Reduce Your Risk

Get annual blood work and lymph node exams if you’re on long-term immunosuppressants or biologics.

Maintain a healthy immune system through balanced nutrition, regular exercise, and adequate sleep.

Avoid smoking and excessive alcohol, both of which compound cancer risk.

Discuss any unexplained fatigue, night sweats, or persistent swelling with your doctor immediately.