Faisal Muhammad Salman, Shaikh Hira, Khattab Ahmed, Albrethsen Mary, Fazal Salman
1 Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA.
2 Department of Hematology-Oncology, Allegheny Health Network, Pittsburgh, PA, USA.
J Oncol Pharm Pract. 2019 Sep;25(6):1486-1490. doi: 10.1177/1078155218788717. Epub 2018 Jul 25.
Ibrutinib has revolutionized the treatment of B-cell malignancies since its approval for chronic lymphocytic leukemia. It is also used in mantle cell lymphoma, diffuse large B-cell lymphoma, Waldenstrom's macroglobulinemia, among others. It is a Bruton's tyrosine kinase inhibitor that acts on B-cell receptor signaling pathway and predisposes to various infections due to its effects on neutrophils, monocytes and T cells. We present a case of cerebral invasive aspergillosis in a patient being treated with ibrutinib for relapsed chronic lymphocytic leukemia. It was hard to associate the condition to ibrutinib versus the chronic lymphocytic leukemia. The patient was successfully treated with a combination of voriconazole and micafungin, resulting in complete recovery and no residual deficits. This highlights the importance of recognizing the rare complication in those on ibrutinib and initiating the treatment immediately with appropriate antifungal agents to improve prognosis of this potentially fatal condition.
自伊布替尼被批准用于治疗慢性淋巴细胞白血病以来，它彻底改变了B细胞恶性肿瘤的治疗方式。它还被用于套细胞淋巴瘤、弥漫性大B细胞淋巴瘤、华氏巨球蛋白血症等疾病的治疗。它是一种布鲁顿酪氨酸激酶抑制剂，作用于B细胞受体信号通路，由于其对中性粒细胞、单核细胞和T细胞的影响，易引发各种感染。我们报告一例正在接受伊布替尼治疗复发性慢性淋巴细胞白血病的患者发生脑侵袭性曲霉病的病例。很难将这种情况与伊布替尼或慢性淋巴细胞白血病联系起来。该患者接受伏立康唑和米卡芬净联合治疗后成功治愈，完全康复且无残留缺陷。这凸显了认识到伊布替尼使用者中这种罕见并发症并立即使用适当抗真菌药物进行治疗以改善这种潜在致命疾病预后的重要性。
