Department of Hematology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China.
Department of Pathology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China.
J Oncol Pharm Pract. 2023 Dec;29(8):2031-2036. doi: 10.1177/10781552231189192. Epub 2023 Jul 30.
Chronic lymphocytic leukemia (CLL) has long been known for its complications related to immune deregulation, of which autoimmune cytopenias (AIC) were frequently reported. Ibrutinib has dramatically changed the overall prognosis of patients with CLL. However, whether ibrutinib can induce or aggravate AIC in CLL patients is still disputable. Here we report a CLL patient with pure red cell aplasia (PRCA) occurring during ibrutinib treatment and review available data to discuss the possible role of ibrutinib in developing AIC.
A 70-year-old female was diagnosed with CLL with indications to initiate ibrutinib treatment given progressive bulky disease. She was admitted for advanced fatigue on the 14th day of ibrutinib monotherapy. A complete blood count revealed severe anemia of hemoglobin (Hb) 37 g/L and a meager reticulocyte count. After excluding other conditions that could cause anemia, PRCA was diagnosed as a complication of CLL.
Ibrutinib was discontinued on the day of admission. At the same time, the patient received prednisone and intravenous immunoglobulin (IVIg). Five days later, the Hb did not improve. Cyclosporine A (CsA) was added; IVIg was discontinued, and prednisone was tapered. Ten days later, the Hb had risen to 92 g/L with a high reticulocyte count of 0.279 × 10/L. The CLL treatment restarted with Zanbrutinib in combination with a low dose of prednisone and CsA. Her CLL was in partial remission by the latest follow-up with an average Hb count.
Our case demonstrates a need to evaluate the risk of developing AIC before initiating ibrutinib. For patients with high-risk factors for AIC episodes, the transient addition of other immunosuppressive therapies should be taken into consideration.
慢性淋巴细胞白血病（CLL）长期以来一直因其免疫失调相关并发症而闻名，其中自身免疫性细胞减少症（AIC）经常被报道。伊布替尼的出现极大地改变了 CLL 患者的整体预后。然而，伊布替尼是否会在 CLL 患者中诱发或加重 AIC 仍存在争议。在此，我们报告一例在伊布替尼治疗期间发生纯红细胞再生障碍性贫血（PRCA）的 CLL 患者，并回顾现有数据讨论伊布替尼在发生 AIC 中的可能作用。
一名 70 岁女性因进行性肿块性疾病而有接受伊布替尼治疗的指征，被诊断为 CLL。在伊布替尼单药治疗的第 14 天，因严重疲劳入院。全血细胞计数显示严重贫血，血红蛋白（Hb）为 37 g/L，网织红细胞计数很少。排除其他可能导致贫血的疾病后，诊断为 CLL 并发症所致 PRCA。
入院当天停用伊布替尼。同时，患者接受泼尼松和静脉注射免疫球蛋白（IVIg）治疗。5 天后，Hb 未改善。加用环孢素 A（CsA）；停用 IVIg，泼尼松逐渐减量。10 天后，Hb 上升至 92 g/L，网织红细胞计数为 0.279×10/L。在最新随访时，CLL 采用 Zanbrutinib 联合小剂量泼尼松和 CsA 治疗达到部分缓解，平均 Hb 计数。
我们的病例表明，在开始伊布替尼治疗前需要评估发生 AIC 的风险。对于有发生 AIC 风险因素的患者，应考虑短暂加用其他免疫抑制疗法。
