title: Incidence and description of autoimmune cytopenias during treatment with ibrutinib for chronic lymphocytic leukemia.
abstract: Chronic lymphocytic leukemia (CLL) is frequently complicated by secondary autoimmune cytopenias (AICs). Ibrutinib is an irreversible inhibitor of Bruton's tyrosine kinase approved for the treatment of relapsed CLL and CLL with del(17p). The effect of ibrutinib treatment on the incidence of AIC is currently unknown. We reviewed medical records of 301 patients treated with ibrutinib, as participants in therapeutic clinical trials at The Ohio State University Comprehensive Cancer Center between July 2010 and July 2014. Subjects were reviewed with respect to past history of AIC, and treatment-emergent AIC cases were identified. Before starting ibrutinib treatment, 26% of patients had experienced AIC. Information was available for a total of 468 patient-years of ibrutinib exposure, during which there were six cases of treatment-emergent AIC. This corresponds to an estimated incidence rate of 13 episodes for every 1000 patient-years of ibrutinib treatment. We further identified 22 patients receiving therapy for AIC at the time ibrutinib was started. Of these 22 patients, 19 were able to discontinue AIC therapy. We found that ibrutinib treatment is associated with a low rate of treatment-emergent AIC. Patients with an existing AIC have been successfully treated with ibrutinib and subsequently discontinued AIC therapy.
authors.affiliation: Division of Hematology, The Ohio State University, Columbus, OH, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Rogers
authors.affiliation: Division of Hematology, The Ohio State University, Columbus, OH, USA.
authors.forename: A S
authors.initials: AS
authors.lastname: Ruppert
authors.affiliation: BMT Program, The Ohio State University, Columbus, OH, USA.
authors.forename: A
authors.initials: A
authors.lastname: Bingman
authors.affiliation: Division of Hematology, The Ohio State University, Columbus, OH, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Andritsos
authors.affiliation: Division of Hematology, The Ohio State University, Columbus, OH, USA.
authors.forename: F T
authors.initials: FT
authors.lastname: Awan
authors.affiliation: Division of Hematology, The Ohio State University, Columbus, OH, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Blum
authors.affiliation: Division of Hematology, The Ohio State University, Columbus, OH, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Flynn
authors.affiliation: Division of Hematology, The Ohio State University, Columbus, OH, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Jaglowski
authors.affiliation: Department of Pathology, The Ohio State University, Columbus, OH, USA.
authors.forename: G
authors.initials: G
authors.lastname: Lozanski
authors.affiliation: Division of Hematology, The Ohio State University, Columbus, OH, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Maddocks
authors.affiliation: Division of Hematology, The Ohio State University, Columbus, OH, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Byrd
authors.affiliation: Division of Hematology, The Ohio State University, Columbus, OH, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Woyach
authors.affiliation: Division of Hematology, The Ohio State University, Columbus, OH, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Jones
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives; D000328:Adult; D000077329:Agammaglobulinaemia Tyrosine Kinase; D000368:Aged; D000369:Aged, 80 and over; D000744:Anemia, Hemolytic, Autoimmune / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010880:Piperidines; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000139:chemically induced* / Q000453:epidemiology; D011720:Pyrazoles / Q000009:adverse effects*; D011743:Pyrimidines / Q000009:adverse effects*
chemical_list: D010880:Piperidines; D011720:Pyrazoles; D011743:Pyrimidines; C551803:ibrutinib; D011505:Protein-Tyrosine Kinases; D000077329:Agammaglobulinaemia Tyrosine Kinase; D000225:Adenine