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Combined salvage ibrutinib/rituximab therapy in chronic lymphocytic leukemia (del17p) with autoimmune cytopenias - case report


Hematology & Transfusion International Journal
Ewa Chmielowska, Anna Krause, Monika Olejniczak

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Abstract

We present a case report of ibrutinib treatment combined with RCD scheme (rituximab, cyclophosphamide and dexamethasone) due to persistent symptoms of autoimmune cytopenia in a patient with chronic lymphocytic leukemia with 17 p deletion. The patient was diagnosed in 2004 and received 5 lines of chemotherapy before ibrutinib. In 2010 the autoimmune cytopenia (AIHA) with haemolytic anemia Coombs positive and thrombocytopenia (IT) was diagnosed. Ibrutinib has started in November 2014. The improvement of mood was observed already after the first 2 months, partial regression of nodal lesions, spleen and liver enlargement during 9 months of treatment. The use of ibrutinib did not affect the course of AIHA and IT. RCD were used concomitantly with ibrutinib and the disappearance of all the symptoms of AIHA and IT was observed..6 RCD cycles were administered.. No toxicity was observed in combination therapy. Symptoms of AIHA and IT never recurred, even at the time of the progression of the disease after 45 months of treatment with ibrutinib. The patient died due to the progression of the disease (despite the use of venetoclax) complicated by pleural empyema, 14 years after first diagnosis.

Keywords

ibrutinib, autoimmune cytopenias, CLL

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