Cardinali Valeria, Coiro Stefano, Martelli Maria Paola, Sportoletti Paolo
Hematology and Clinical Immunology Section, Department of Medicine and Surgery, Center for Hemato-Oncological Research (CREO), University of Perugia, P.le Menghini 8/9, Perugia, 06123, Italy.
Cardiology Department, Santa Maria della Misericordia Hospital, Perugia, Italy.
Ann Hematol. 2025 Jun 19. doi: 10.1007/s00277-025-06457-0.
Brugada syndrome (BS) is a genetic condition that predisposes individuals to life-threatening arrhythmias, posing a challenge in the management of chronic lymphocytic leukemia (CLL). While BTK inhibitors have been associated with ventricular arrhythmias, data on the cardiac safety of venetoclax and obinutuzumab in BS patients remain limited. We describe the case of a 60-year-old CLL patient with a baseline type 2 Brugada ECG pattern who was treated with venetoclax plus obinutuzumab due to concerns over BTK inhibitor-associated cardiac risks. During the first obinutuzumab infusion, the patient experienced an infusion-related reaction with hypotension, hypokalemia, and transient conversion to a type 1 Brugada ECG pattern. Supportive measures, including electrolyte correction, led to ECG normalization. Venetoclax was well tolerated, and the patient achieved a complete response with undetectable measurable residual disease. This case underscores the importance of cardiac monitoring in CLL patients with BS and suggests that venetoclax plus obinutuzumab may represent a safe and effective therapeutic alternative when BTK inhibitors are contraindicated.
布鲁加达综合征（BS）是一种遗传性疾病，使个体易患危及生命的心律失常，这给慢性淋巴细胞白血病（CLL）的治疗带来了挑战。虽然布鲁顿酪氨酸激酶（BTK）抑制剂与室性心律失常有关，但关于维奈克拉和奥滨尤妥珠单抗在BS患者中的心脏安全性数据仍然有限。我们描述了一例60岁的CLL患者，其基线心电图为2型布鲁加达模式，由于担心BTK抑制剂相关的心脏风险，接受了维奈克拉加奥滨尤妥珠单抗治疗。在首次输注奥滨尤妥珠单抗期间，患者出现了与输注相关的反应，伴有低血压、低钾血症，并短暂转变为1型布鲁加达心电图模式。包括电解质纠正在内的支持措施使心电图恢复正常。维奈克拉耐受性良好，患者实现了完全缓解，可检测到的可测量残留疾病为阴性。该病例强调了对患有BS的CLL患者进行心脏监测的重要性，并表明当BTK抑制剂禁忌时，维奈克拉加奥滨尤妥珠单抗可能是一种安全有效的治疗选择。
