title: Walking a tightrope: clinical use of ibrutinib in mantle cell lymphoma in the elderly.
abstract: Representative clinical case. A 74-year-old male patient was diagnosed with stage 3 mantle cell lymphoma in 2012. Because he was ineligible for intensive treatment (age, previous myocardial infarction [MI]), he received rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemoimmunotherapy for 6 cycles (reaching complete response) and then rituximab maintenance (RM) for 2 years. One year after the end of RM, he relapsed with disseminated disease. He was started on ibrutinib 560 mg/day. Two weeks after the start of ibrutinib, he developed grade 3 diarrhea that required interruption of ibrutinib. Two weeks after the regular dose was restarted (month 3), the patient had repeated bleeding (patient was receiving aspirin for previous MI) and had to stop ibrutinib again. Because the patient was in partial response (PR) with lack of disease-associated symptoms, he was restarted on ibrutinib 280 mg/day with no further adverse events, and he had maintained PR at last follow-up (month 9 on ibrutinib).
authors.affiliation: Center for Cellular Immunotherapies, and.|Department of Pathology and Laboratory Medicine, Perelman School of Medicine, and.|Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: Marco
authors.initials: M
authors.lastname: Ruella
authors.affiliation: Department of Medical Oncology, Institut Bergonie, Bordeaux, France.|U1218 INSERM Research Unit, Bordeaux, France; and.|Sites de Recherche Intégrée sur le Cancer, Bordeaux Recherche Intégrée Oncologie, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Soubeyran
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage*; D003967:Diarrhea / Q000139:chemically induced*; D006470:Hemorrhage / Q000139:chemically induced / Q000188:drug therapy; D006801:Humans; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy*; D008297:Male; D009367:Neoplasm Staging; D010880:Piperidines; D011720:Pyrazoles / Q000008:administration & dosage* / Q000009:adverse effects*; D011743:Pyrimidines / Q000008:administration & dosage* / Q000009:adverse effects*
chemical_list: D010880:Piperidines; D011720:Pyrazoles; D011743:Pyrimidines; C551803:ibrutinib; D000225:Adenine; D001241:Aspirin