Barts Cancer Institute, Queen Mary University of London, London, UK.
Department of Haematology, Vall d'Hebron University Hospital, Barcelona, Spain.
Br J Haematol. 2018 Mar;180(5):666-679. doi: 10.1111/bjh.15080. Epub 2018 Jan 9.
Ibrutinib is indicated in Europe for the treatment of several B-cell malignancies, including chronic lymphocytic leukaemia (CLL). However, despite the high efficacy and favourable toxicity profile of ibrutinib, recent data suggest that it is not always administered optimally in clinical practice, with an increased tendency for dose reduction and a higher frequency of discontinuation. An expert panel of European haematologists was convened to identify practical issues pertinent to physicians involved in the therapeutic management of ibrutinib-treated CLL patients and here we outline the findings. Practical management recommendations are given for treating patients with ibrutinib and clinical considerations for the management of adverse events (AEs) that can be associated with ibrutinib treatment are addressed. This article highlights that patients should be monitored for treatment emergent adverse events, most of which are mild, transient and generally occur early in therapy and that, even with more challenging AEs, patients can often be maintained on therapy with minimal disruption through careful management. The necessity to use the correct ibrutinib dose, along with increased awareness, vigilance, mitigation and management of AEs, are all recommended to maximise outcomes for CLL patients treated with ibrutinib.
伊布替尼在欧洲被批准用于治疗多种 B 细胞恶性肿瘤，包括慢性淋巴细胞白血病（CLL）。然而，尽管伊布替尼具有高效性和良好的毒性特征，但最近的数据表明，在临床实践中，它并不总是得到最佳应用，剂量减少的趋势增加，停药的频率更高。一个由欧洲血液学家组成的专家小组被召集来确定与参与治疗伊布替尼治疗的 CLL 患者的治疗管理相关的实际问题，在此我们概述了这些发现。为接受伊布替尼治疗的患者提供了实用的管理建议，并针对可能与伊布替尼治疗相关的不良事件（AE）的管理提出了临床考虑因素。本文强调，应监测治疗中出现的不良事件，其中大多数是轻度、短暂的，通常发生在治疗早期，即使出现更具挑战性的 AE，通过仔细管理，通常也可以使患者继续治疗而不会造成太大干扰。为了使接受伊布替尼治疗的 CLL 患者获得最大的治疗效果，建议使用正确的伊布替尼剂量，并提高对 AE 的认识、警惕性、减轻和管理。
