Early-onset invasive aspergillosis and other fungal infections in patients treated with ibrutinib

Blood. 2018 Apr 26;131(17):1955-1959. doi: 10.1182/blood-2017-11-818286. Epub 2018 Feb 1.

Abstract

Ibrutinib has revolutionized the management of chronic lymphocytic leukemia and is now being increasingly used. Although considered to be less immunosuppressive than conventional immunochemotherapy, the observation of a few cases of invasive fungal infections in patients treated with ibrutinib prompted us to conduct a retrospective survey. We identified 33 cases of invasive fungal infections in patients receiving ibrutinib alone or in combination. Invasive aspergillosis (IA) was overrepresented (27/33) and was associated with cerebral localizations in 40% of the cases. Remarkably, most cases of invasive fungal infections occurred with a median of 3 months after starting ibrutinib. In 18/33 cases, other conditions that could have contributed to decreased antifungal responses, such as corticosteroids, neutropenia, or combined immunochemotherapy, were present. These observations indicate that ibrutinib may be associated with early-onset invasive fungal infections, in particular IA with frequent cerebral involvement, and that patients on ibrutinib should be closely monitored in particular when other risk factors of fungal infections are present.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Observational Study

MeSH terms

  • Adenine / analogs & derivatives
  • Aspergillosis / chemically induced*
  • Aspergillosis / epidemiology*
  • Female
  • Humans
  • Leukemia, Lymphocytic, Chronic, B-Cell / drug therapy*
  • Leukemia, Lymphocytic, Chronic, B-Cell / epidemiology*
  • Leukemia, Lymphocytic, Chronic, B-Cell / microbiology
  • Male
  • Piperidines
  • Pyrazoles / administration & dosage*
  • Pyrazoles / adverse effects*
  • Pyrimidines / administration & dosage*
  • Pyrimidines / adverse effects*
  • Time Factors

Substances

  • Piperidines
  • Pyrazoles
  • Pyrimidines
  • ibrutinib
  • Adenine