Which DMARD class is avoided in lymphoma?

• A. TNF inhibitors
• B. Methotrexate
• C. Leflunomide
• D. Hydroxychloroquine

Answer: (A)

In this context, the key idea is that some DMARDs suppress immune functions in a way that can affect cancer control. Tumor necrosis factor (TNF) inhibitors blunt a major inflammatory pathway that also plays a role in immune surveillance against tumors. Because of this, using TNF inhibitors in patients with lymphoma (active disease or a history of lymphoma) is avoided to reduce the risk of lymphoma progression or relapse. Other DMARDs like methotrexate or leflunomide are immunosuppressive but are not as strongly associated with lymphoma risk and can be used with caution in appropriate cancer contexts, while hydroxychloroquine is generally considered safer with respect to malignancy risk. Therefore, the class to avoid in lymphoma is TNF inhibitors.