A case of chronic lymphocytic leukemia complicated by autoimmune hemolytic anemia due to ibrutinib treatment

Journal of Clinical and Experimental Hematopathology : JCEH
Takaharu SuzukiSadao Aoki

Abstract

Ibrutinib (IBR) covalently binds to the active site of Bruton's tyrosine kinase (BTK) and is used for the treatment of relapsed/refractory chronic lymphocytic leukemia (CLL). Approximately 5-10% of CLL is complicated by autoimmune cytopenia (AIC), such as autoimmune hemolytic anemia (AIHA). Several cases of AIC have reportedly demonstrated improvement during IBR treatment. However, in our case, the patient developed AIHA during oral IBR treatment. As AIHA is exacerbated by the increased number of CLL cells in the peripheral blood, it may have developed because of disease progression rather than IBR use. This phenomenon may also be attributed to the production of autoantibodies due to increased number of CD5+ B cells. In this case, withdrawal of IBR and administration of rituximab improved hemolysis. If AIHA develops during treatment, its etiology must be examined to confirm the effects of treatment.

References

Jun 8, 2010·Annals of Hematology·Francisco Javier PeñalverUNKNOWN Multi-institutional Retrospective Study on the use of rituximab in refractory AIHA
Jul 14, 2010·Best Practice & Research. Clinical Haematology·Clive S Zent, Neil E Kay
Nov 6, 2012·Leukemia & Lymphoma·Rosa Ruchlemer, Aaron Polliack
Jun 11, 2014·American Journal of Hematology·Carlo ViscoFrancesco Rodeghiero
Feb 27, 2015·British Journal of Haematology·Sudhir MandaAlexey V Danilov
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Feb 17, 2017·Case Reports in Oncology·Aliénor GalinierMathieu Puyade

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Citations

Aug 17, 2021·The Cancer Journal·Nil Albiol, Carol Moreno
Apr 10, 2019·Acta Haematologica·Ilana LevyTamar Tadmor

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Methods Mentioned

BETA
flow cytometry
bone marrow aspiration

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