Shaikh Hira, Khattab Ahmed, Faisal Muhammad S, Chilkulwar Abhishek, Albrethsen Mary, Sadashiv Santhosh, Fazal Salman
1 Department of Internal Medicine, Allegheny Health Network, Pittsburgh, USA.
2 Hematology-Oncology, MD Anderson Cancer Center, USA.
J Oncol Pharm Pract. 2019 Jul;25(5):1265-1270. doi: 10.1177/1078155218788707. Epub 2018 Jul 25.
Ibrutinib, a Bruton's tyrosine kinase inhibitor has reformed the treatment of various B-cell malignancies including chronic lymphocytic leukemia, mantle cell lymphoma, and Waldenstrom's macroglobulinemia. Although generally well tolerated, here we describe our institutional experience of unique adverse effects encountered with the use of ibrutinib in patients with B-cell lymphomas.
This is a retrospective observational study done at a tertiary care facility, to evaluate adverse events in patients with B-cell malignancies on treatment with ibrutinib between 2014 and 2018. Further details including type of malignancy, cytogenetics, interventions for treatment of the side effect, and outcomes were obtained through electronic health record.
We found 10 patients with unique adverse events related to ibrutinib. Among those, six had chronic lymphocytic leukemia, two had Waldenstrom's macroglobulinemia, and two had mantle cell lymphoma. The events included palindromic rheumatoid arthritis, diffuse spongiotic dermatitis, bullous pemphigoid, recurrent hemorrhagic stroke, peripheral neuropathy, recurrent paronychia, intramedullary fibrosis, recurrent joint pains, pulmonary aspergillosis, dyspnea with exacerbation of atrial fibrillation, and resolution of autoimmune hemolytic anemia.
Our case series illustrates the wide variety of unique events recognized in patients treated with ibrutinib, some of which required cessation and most had dose reduction of the treatment. Thus, stressing the importance of early identification and intervention for the events to avoid worsening of toxicity and inability to continue treatment in such patients.
依鲁替尼，一种布鲁顿酪氨酸激酶抑制剂，已经改变了包括慢性淋巴细胞白血病、套细胞淋巴瘤和华氏巨球蛋白血症在内的各种B细胞恶性肿瘤的治疗方式。尽管总体耐受性良好，但在此我们描述了我们机构在使用依鲁替尼治疗B细胞淋巴瘤患者时遇到的独特不良反应的经验。
这是一项在三级医疗保健机构进行的回顾性观察研究，旨在评估2014年至2018年间接受依鲁替尼治疗的B细胞恶性肿瘤患者的不良事件。通过电子健康记录获取了包括恶性肿瘤类型、细胞遗传学、副作用治疗干预措施及结果等进一步细节。
我们发现10例与依鲁替尼相关的独特不良事件患者。其中，6例患有慢性淋巴细胞白血病，2例患有华氏巨球蛋白血症，2例患有套细胞淋巴瘤。这些事件包括回纹型类风湿关节炎、弥漫性海绵状皮炎、大疱性类天疱疮、复发性出血性中风、周围神经病变、复发性甲沟炎、骨髓纤维化、复发性关节疼痛、肺曲霉病、呼吸困难伴房颤加重以及自身免疫性溶血性贫血缓解。
我们的病例系列说明了在接受依鲁替尼治疗的患者中认识到的各种各样独特事件，其中一些需要停药，大多数需要减少治疗剂量。因此，强调了对这些事件进行早期识别和干预的重要性，以避免此类患者毒性恶化和无法继续治疗。
