Two Distinct Clinical Patterns of Ibrutinib-to-Venetoclax Transition in Relapsed Chronic Lymphocytic Leukemia Patients
Patients with chronic lymphocytic leukemia (CLL) relapsing on ibrutinib are often treated with the Bcl-2 inhibitor venetoclax. However, the transition from one agent to another poses some clinical challenges due to disease flares sometimes occurring right after ibrutinib interruption. Here, we descr...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-04-01
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| Series: | Current Oncology |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1718-7729/29/4/227 |
| _version_ | 1797436148542341120 |
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| author | Isacco Ferrarini Francesca Gandini Ettore Zapparoli Antonella Rigo |
| author_facet | Isacco Ferrarini Francesca Gandini Ettore Zapparoli Antonella Rigo |
| author_sort | Isacco Ferrarini |
| collection | DOAJ |
| description | Patients with chronic lymphocytic leukemia (CLL) relapsing on ibrutinib are often treated with the Bcl-2 inhibitor venetoclax. However, the transition from one agent to another poses some clinical challenges due to disease flares sometimes occurring right after ibrutinib interruption. Here, we describe three clinical vignettes highlighting two distinct patterns of ibrutinib-to-venetoclax transition. While patients following the favorable pattern transited to venetoclax without experiencing disease flare, the one patient who took the unfavorable path showed rapid disease rebound, with large-cell transformation occurring one week after ibrutinib interruption. A high burden of <i>BTK</i> and <i>PLCG2</i> mutations was found only in patients with the favorable transition pattern, suggesting that removing BTK inhibition might be particularly harmful if CLL cells are progressing through mechanisms external to the BTK axis. |
| first_indexed | 2024-03-09T10:58:23Z |
| format | Article |
| id | doaj.art-9198405ffd244664a9e83eef241394be |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-09T10:58:23Z |
| publishDate | 2022-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-9198405ffd244664a9e83eef241394be2023-12-01T01:27:47ZengMDPI AGCurrent Oncology1198-00521718-77292022-04-012942792279710.3390/curroncol29040227Two Distinct Clinical Patterns of Ibrutinib-to-Venetoclax Transition in Relapsed Chronic Lymphocytic Leukemia PatientsIsacco Ferrarini0Francesca Gandini1Ettore Zapparoli2Antonella Rigo3Section of Hematology, Department of Medicine, University of Verona, 37134 Verona, ItalyB-Cell Neoplasia Unit, Division of Experimental Oncology, Università Vita-Salute San Raffaele, 20132 Milan, ItalyCentre for Omics Sciences, IRCCS Ospedale San Raffaele, 20132 Milan, ItalySection of Hematology, Department of Medicine, University of Verona, 37134 Verona, ItalyPatients with chronic lymphocytic leukemia (CLL) relapsing on ibrutinib are often treated with the Bcl-2 inhibitor venetoclax. However, the transition from one agent to another poses some clinical challenges due to disease flares sometimes occurring right after ibrutinib interruption. Here, we describe three clinical vignettes highlighting two distinct patterns of ibrutinib-to-venetoclax transition. While patients following the favorable pattern transited to venetoclax without experiencing disease flare, the one patient who took the unfavorable path showed rapid disease rebound, with large-cell transformation occurring one week after ibrutinib interruption. A high burden of <i>BTK</i> and <i>PLCG2</i> mutations was found only in patients with the favorable transition pattern, suggesting that removing BTK inhibition might be particularly harmful if CLL cells are progressing through mechanisms external to the BTK axis.https://www.mdpi.com/1718-7729/29/4/227ibrutinibvenetoclaxchronic lymphocytic leukemia |
| spellingShingle | Isacco Ferrarini Francesca Gandini Ettore Zapparoli Antonella Rigo Two Distinct Clinical Patterns of Ibrutinib-to-Venetoclax Transition in Relapsed Chronic Lymphocytic Leukemia Patients Current Oncology ibrutinib venetoclax chronic lymphocytic leukemia |
| title | Two Distinct Clinical Patterns of Ibrutinib-to-Venetoclax Transition in Relapsed Chronic Lymphocytic Leukemia Patients |
| title_full | Two Distinct Clinical Patterns of Ibrutinib-to-Venetoclax Transition in Relapsed Chronic Lymphocytic Leukemia Patients |
| title_fullStr | Two Distinct Clinical Patterns of Ibrutinib-to-Venetoclax Transition in Relapsed Chronic Lymphocytic Leukemia Patients |
| title_full_unstemmed | Two Distinct Clinical Patterns of Ibrutinib-to-Venetoclax Transition in Relapsed Chronic Lymphocytic Leukemia Patients |
| title_short | Two Distinct Clinical Patterns of Ibrutinib-to-Venetoclax Transition in Relapsed Chronic Lymphocytic Leukemia Patients |
| title_sort | two distinct clinical patterns of ibrutinib to venetoclax transition in relapsed chronic lymphocytic leukemia patients |
| topic | ibrutinib venetoclax chronic lymphocytic leukemia |
| url | https://www.mdpi.com/1718-7729/29/4/227 |
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