INFECTIOUS COMPLICATIONS IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKAEMIA TREATED WITH IBRUTINIB
(Abstract release date: 05/18/17)
EHA Library. Wasik-Szczepaanek E. 05/18/17; 182514; PB1800
Ewa Wasik-Szczepaanek
Contributions
Contributions
Abstract
Abstract: PB1800
Type: Publication Only
Background
Chronic lymphocytic leukaemia (CLL) is characterised by frequent co-existent infectious complications. They stem from, among other things, hypogammaglobulinemia, which is connected with CLL, and correlates with the disease duration and severity, as well as T-lymphocyte function disorders. The application of innovative therapies (chemoimmunotherapy) on the one hand facilitates considerable improvements in treatment outcomes and on the other hand it increases the risk of life-threatening infectious complications. The introduction of a new drug, ibrutinib (Bruton's kinase inhibitor), has created a unique opportunity for CLL patients, especially those with prognostically unfavourable genetic aberrations (del17p), or in the case of whom previous chemotherapies have failed to give satisfying results. Previous observations indicate the risk of side effects (e.g. bleeding, infectious complications, heart rhythm disorders) which might sometimes limit the applicability of ibrutinib in some CLL patients.
Aims
The aim of this paper was to evaluate the risk of infectious complications in persons with CLL, and to determine potential correlations between possible infectious complications and selected clinical, morphological and biochemical parameters.
Methods
The study comprised 43 CLL patients aged 48-82 years (average age 67 years), 18 women and 25 men. At the beginning of the ibrutinib therapy the patient’s disease was at the 2-4 clinical stage, according to Rai et al. Usually they were individuals who had received a couple of previous chemotherapies (from 1 to 7) which contained, inter alia, purine analogues, and the monoclonal antibodies (rituximab, alemtuzumab, ofatumumab). Ibrutinib was administered at a dose of 420 mg/d.
Results
Infectious complications were observed in 16 patients (37.2%). These included, for example, upper respiratory tract infection, bronchitis, pneumonia, urinary-tract infections, pharyngitis. The conducted analysis showed a statistically significant correlation between the concentration of IgM in the blood serum (before ibrutinib administration) and infectious complications during these therapy (p<0.05). The average IgM concentration in patients with complications was considerably lower when compared to people who did not experience any complications. The patients (n=3; 6,98%) with complications at the moment of the CLL diagnosis also had them during the ibrutinib treatment. This phenomenon was confirmed in 13 patients (33%) in the other group. The correlation was borderline significant (p=0.09). Infectious complications were observed more frequently in the patients with 3-4 stage CLL (according to Rai et al.) than in the individuals at the less-advanced clinical stages of the disease (0-2), and this correlation also showed borderline significance (p=0.08). No significant correlation was detected between the risk of infectious complications and earlier therapy with purine analogues and neutropenic episodes during the ibrutinib therapy.
Conclusion
Ibrutinib is considered to be a real breakthrough in CLL treatment; but it has to be borne in mind that the drug gives possible side effects which might occur during therapy. They include infectious complications which are among the main causes of death in this group of patients. The results obtained by us indicate that the risk of infection during ibrutinib therapy relates mainly to patients with low IgM concentration in the blood serum and at more advanced clinical stages of the disease. In this case the occurrence of previous complications (before ibrutinib administration) is also relevant. We are aware of the limitations of our work related to the small number of patients. Yet, even at this stage, it is possible to select CLL patients with increased risk of such usually life-threatening complications.
Session topic: 6. Chronic lymphocytic leukemia and related disorders - Clinical
Abstract: PB1800
Type: Publication Only
Background
Chronic lymphocytic leukaemia (CLL) is characterised by frequent co-existent infectious complications. They stem from, among other things, hypogammaglobulinemia, which is connected with CLL, and correlates with the disease duration and severity, as well as T-lymphocyte function disorders. The application of innovative therapies (chemoimmunotherapy) on the one hand facilitates considerable improvements in treatment outcomes and on the other hand it increases the risk of life-threatening infectious complications. The introduction of a new drug, ibrutinib (Bruton's kinase inhibitor), has created a unique opportunity for CLL patients, especially those with prognostically unfavourable genetic aberrations (del17p), or in the case of whom previous chemotherapies have failed to give satisfying results. Previous observations indicate the risk of side effects (e.g. bleeding, infectious complications, heart rhythm disorders) which might sometimes limit the applicability of ibrutinib in some CLL patients.
Aims
The aim of this paper was to evaluate the risk of infectious complications in persons with CLL, and to determine potential correlations between possible infectious complications and selected clinical, morphological and biochemical parameters.
Methods
The study comprised 43 CLL patients aged 48-82 years (average age 67 years), 18 women and 25 men. At the beginning of the ibrutinib therapy the patient’s disease was at the 2-4 clinical stage, according to Rai et al. Usually they were individuals who had received a couple of previous chemotherapies (from 1 to 7) which contained, inter alia, purine analogues, and the monoclonal antibodies (rituximab, alemtuzumab, ofatumumab). Ibrutinib was administered at a dose of 420 mg/d.
Results
Infectious complications were observed in 16 patients (37.2%). These included, for example, upper respiratory tract infection, bronchitis, pneumonia, urinary-tract infections, pharyngitis. The conducted analysis showed a statistically significant correlation between the concentration of IgM in the blood serum (before ibrutinib administration) and infectious complications during these therapy (p<0.05). The average IgM concentration in patients with complications was considerably lower when compared to people who did not experience any complications. The patients (n=3; 6,98%) with complications at the moment of the CLL diagnosis also had them during the ibrutinib treatment. This phenomenon was confirmed in 13 patients (33%) in the other group. The correlation was borderline significant (p=0.09). Infectious complications were observed more frequently in the patients with 3-4 stage CLL (according to Rai et al.) than in the individuals at the less-advanced clinical stages of the disease (0-2), and this correlation also showed borderline significance (p=0.08). No significant correlation was detected between the risk of infectious complications and earlier therapy with purine analogues and neutropenic episodes during the ibrutinib therapy.
Conclusion
Ibrutinib is considered to be a real breakthrough in CLL treatment; but it has to be borne in mind that the drug gives possible side effects which might occur during therapy. They include infectious complications which are among the main causes of death in this group of patients. The results obtained by us indicate that the risk of infection during ibrutinib therapy relates mainly to patients with low IgM concentration in the blood serum and at more advanced clinical stages of the disease. In this case the occurrence of previous complications (before ibrutinib administration) is also relevant. We are aware of the limitations of our work related to the small number of patients. Yet, even at this stage, it is possible to select CLL patients with increased risk of such usually life-threatening complications.
Session topic: 6. Chronic lymphocytic leukemia and related disorders - Clinical
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