Woo Timothy, Carter Matthew, Follows George, Patten Piers Em
Department of Haematology, King's College Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom.
Department of Haematology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom.
Front Oncol. 2023 Oct 18;13:1260003. doi: 10.3389/fonc.2023.1260003. eCollection 2023.
In chronic lymphocytic leukaemia (CLL), immune dysregulation is common and can manifest as immune thrombocytopenia (ITP). Corticosteroids are the mainstay for front-line management of CLL-associated ITP. Therapy refractoriness represents a clinical challenge and is an indication to commence CLL-directed treatment, historically with anti-CD20 antibody-based chemoimmunotherapy. There is a small but growing body of evidence supporting the use of Bruton's tyrosine kinase (BTK) inhibitors in this setting, but not the B-cell lymphoma-2 inhibitor, venetoclax. Here, we describe two cases of refractory ITP in patients with CLL who successfully achieved and sustained complete remission with fixed-duration venetoclax monotherapy. Responses were rapid and durable and not explained by the concomitant use of an anti-CD20 antibody. This supports a dual role for single-agent venetoclax in managing active CLL and associated ITP as an alternative to BTK inhibitors and anti-CD20 monoclonals.
在慢性淋巴细胞白血病（CLL）中，免疫失调很常见，可表现为免疫性血小板减少症（ITP）。皮质类固醇是CLL相关ITP一线治疗的主要手段。治疗难治性是一项临床挑战，也是开始针对CLL进行治疗的指征，传统上采用基于抗CD20抗体的化学免疫疗法。有少量但不断增加的证据支持在这种情况下使用布鲁顿酪氨酸激酶（BTK）抑制剂，但不支持使用B细胞淋巴瘤-2抑制剂维奈克拉。在此，我们描述了两例CLL患者难治性ITP的病例，他们通过固定疗程的维奈克拉单药治疗成功实现并维持了完全缓解。缓解迅速且持久，并非由同时使用抗CD20抗体所致。这支持了单药维奈克拉在治疗活动性CLL和相关ITP方面的双重作用，可作为BTK抑制剂和抗CD20单克隆抗体的替代方案。
