HEMORRHAGIC EVENTS AND PRIMARY HEMOSTASIS DISORDERS DURING TREATMENT WITH IBRUTINIB.
(Abstract release date: 05/19/16)
EHA Library. Aguado Bueno B. 06/09/16; 132538; E989
Dr. Beatriz Aguado Bueno
Contributions
Contributions
Abstract
Abstract: E989
Type: Eposter Presentation
Background
Ibrutinib is a first-in-class Bruton kinase inhibitor (BTK) registered for the treatment of Chronic Lymphocytic Leukemia (CLL), mantle cell lymphoma (MCL) and Waldenström Macroglobulinemia (WM). Increased risk of bleeding events are associated with ibrutinib, mostly grade ≤2. Probable mechanism for this risk could be the role of BTK in platelet activation via GPIb, GPVI and FVW.
Aims
To present our experience regarding hemorrhagic events and hemostasis tests alterations in CLL patients (pts) treated with ibrutinib.
Methods
10 pts with relapsed CLL were started on ibrutinib between december/2012 and march/2016. Median age was 69 years (range: 42-83 years). 8 of them were male. Median exposure to the drug was 17 months (range 1- 38)After 9 to 36 months from initiation of treatment (median 22 months) 6/10 were thoroughly interviewed about personal history of bleeding events and the following laboratory work was performed: factor VIII level, FvW antigen and activity, platelet function analysis (PFA-100TM) with ADP and epinephrine, and aggregation studies with collagen, ADP and arachidonic acid (AA). Along this tests all patients had blood counts with platelets more than 100 x 10e9/L.
Results
2 out of 10 pts had bleeding events (grade 1 or 2), consisting in spontaneous bruising, in the first weeks of treatment. 4 pts underwent minor invasive procedures with no complications, withholding the drug at least 3 days before and after. 2 pts were on concomitant antiplatelet (1) or anticoagulant (1, LMWH, due to AF) and had no bleeding events.All pts tested (6/6) had normal or slightly elevated levels of F VIII, FvW:Ag and FvW:ristocetin cofactor activity. 2 pts had abnormal PFA-100TM and abnormal aggregations with every agonist. One case had normal PFA-100 TM while aggregations with collagen and AA were mildly altered.
Conclusion
Our limited experience shows a moderate risk of minor bleedings consisting with a platelet disfunction. Despite the fact that we have no baseline tests done, alterations in primary hemostasis tests, including PFA-100TM and specially aggregometry could be expected early on after exposure to ibrutinib.
Session topic: E-poster
Keyword(s): Aggregation, Bleeding, Chronic lymphocytic leukemia, Tyrosine kinase inhibitor
Type: Eposter Presentation
Background
Ibrutinib is a first-in-class Bruton kinase inhibitor (BTK) registered for the treatment of Chronic Lymphocytic Leukemia (CLL), mantle cell lymphoma (MCL) and Waldenström Macroglobulinemia (WM). Increased risk of bleeding events are associated with ibrutinib, mostly grade ≤2. Probable mechanism for this risk could be the role of BTK in platelet activation via GPIb, GPVI and FVW.
Aims
To present our experience regarding hemorrhagic events and hemostasis tests alterations in CLL patients (pts) treated with ibrutinib.
Methods
10 pts with relapsed CLL were started on ibrutinib between december/2012 and march/2016. Median age was 69 years (range: 42-83 years). 8 of them were male. Median exposure to the drug was 17 months (range 1- 38)After 9 to 36 months from initiation of treatment (median 22 months) 6/10 were thoroughly interviewed about personal history of bleeding events and the following laboratory work was performed: factor VIII level, FvW antigen and activity, platelet function analysis (PFA-100TM) with ADP and epinephrine, and aggregation studies with collagen, ADP and arachidonic acid (AA). Along this tests all patients had blood counts with platelets more than 100 x 10e9/L.
Results
2 out of 10 pts had bleeding events (grade 1 or 2), consisting in spontaneous bruising, in the first weeks of treatment. 4 pts underwent minor invasive procedures with no complications, withholding the drug at least 3 days before and after. 2 pts were on concomitant antiplatelet (1) or anticoagulant (1, LMWH, due to AF) and had no bleeding events.All pts tested (6/6) had normal or slightly elevated levels of F VIII, FvW:Ag and FvW:ristocetin cofactor activity. 2 pts had abnormal PFA-100TM and abnormal aggregations with every agonist. One case had normal PFA-100 TM while aggregations with collagen and AA were mildly altered.
Conclusion
Our limited experience shows a moderate risk of minor bleedings consisting with a platelet disfunction. Despite the fact that we have no baseline tests done, alterations in primary hemostasis tests, including PFA-100TM and specially aggregometry could be expected early on after exposure to ibrutinib.
Session topic: E-poster
Keyword(s): Aggregation, Bleeding, Chronic lymphocytic leukemia, Tyrosine kinase inhibitor
Abstract: E989
Type: Eposter Presentation
Background
Ibrutinib is a first-in-class Bruton kinase inhibitor (BTK) registered for the treatment of Chronic Lymphocytic Leukemia (CLL), mantle cell lymphoma (MCL) and Waldenström Macroglobulinemia (WM). Increased risk of bleeding events are associated with ibrutinib, mostly grade ≤2. Probable mechanism for this risk could be the role of BTK in platelet activation via GPIb, GPVI and FVW.
Aims
To present our experience regarding hemorrhagic events and hemostasis tests alterations in CLL patients (pts) treated with ibrutinib.
Methods
10 pts with relapsed CLL were started on ibrutinib between december/2012 and march/2016. Median age was 69 years (range: 42-83 years). 8 of them were male. Median exposure to the drug was 17 months (range 1- 38)After 9 to 36 months from initiation of treatment (median 22 months) 6/10 were thoroughly interviewed about personal history of bleeding events and the following laboratory work was performed: factor VIII level, FvW antigen and activity, platelet function analysis (PFA-100TM) with ADP and epinephrine, and aggregation studies with collagen, ADP and arachidonic acid (AA). Along this tests all patients had blood counts with platelets more than 100 x 10e9/L.
Results
2 out of 10 pts had bleeding events (grade 1 or 2), consisting in spontaneous bruising, in the first weeks of treatment. 4 pts underwent minor invasive procedures with no complications, withholding the drug at least 3 days before and after. 2 pts were on concomitant antiplatelet (1) or anticoagulant (1, LMWH, due to AF) and had no bleeding events.All pts tested (6/6) had normal or slightly elevated levels of F VIII, FvW:Ag and FvW:ristocetin cofactor activity. 2 pts had abnormal PFA-100TM and abnormal aggregations with every agonist. One case had normal PFA-100 TM while aggregations with collagen and AA were mildly altered.
Conclusion
Our limited experience shows a moderate risk of minor bleedings consisting with a platelet disfunction. Despite the fact that we have no baseline tests done, alterations in primary hemostasis tests, including PFA-100TM and specially aggregometry could be expected early on after exposure to ibrutinib.
Session topic: E-poster
Keyword(s): Aggregation, Bleeding, Chronic lymphocytic leukemia, Tyrosine kinase inhibitor
Type: Eposter Presentation
Background
Ibrutinib is a first-in-class Bruton kinase inhibitor (BTK) registered for the treatment of Chronic Lymphocytic Leukemia (CLL), mantle cell lymphoma (MCL) and Waldenström Macroglobulinemia (WM). Increased risk of bleeding events are associated with ibrutinib, mostly grade ≤2. Probable mechanism for this risk could be the role of BTK in platelet activation via GPIb, GPVI and FVW.
Aims
To present our experience regarding hemorrhagic events and hemostasis tests alterations in CLL patients (pts) treated with ibrutinib.
Methods
10 pts with relapsed CLL were started on ibrutinib between december/2012 and march/2016. Median age was 69 years (range: 42-83 years). 8 of them were male. Median exposure to the drug was 17 months (range 1- 38)After 9 to 36 months from initiation of treatment (median 22 months) 6/10 were thoroughly interviewed about personal history of bleeding events and the following laboratory work was performed: factor VIII level, FvW antigen and activity, platelet function analysis (PFA-100TM) with ADP and epinephrine, and aggregation studies with collagen, ADP and arachidonic acid (AA). Along this tests all patients had blood counts with platelets more than 100 x 10e9/L.
Results
2 out of 10 pts had bleeding events (grade 1 or 2), consisting in spontaneous bruising, in the first weeks of treatment. 4 pts underwent minor invasive procedures with no complications, withholding the drug at least 3 days before and after. 2 pts were on concomitant antiplatelet (1) or anticoagulant (1, LMWH, due to AF) and had no bleeding events.All pts tested (6/6) had normal or slightly elevated levels of F VIII, FvW:Ag and FvW:ristocetin cofactor activity. 2 pts had abnormal PFA-100TM and abnormal aggregations with every agonist. One case had normal PFA-100 TM while aggregations with collagen and AA were mildly altered.
Conclusion
Our limited experience shows a moderate risk of minor bleedings consisting with a platelet disfunction. Despite the fact that we have no baseline tests done, alterations in primary hemostasis tests, including PFA-100TM and specially aggregometry could be expected early on after exposure to ibrutinib.
Session topic: E-poster
Keyword(s): Aggregation, Bleeding, Chronic lymphocytic leukemia, Tyrosine kinase inhibitor
{{ help_message }}
{{filter}}