Zanubrutinib-induced liver injury: a case report and literature review
Abstract Background Zanubrutinib is a Bruton’s tyrosine kinase inhibitor that has been recently licensed in refractory mantle cell lymphoma and under assessment in phase 3 clinical trials for other B cell malignancies. To date, there are no reported cases of hepatotoxicity secondary to zanubrutinib....
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| Format: | Article |
| Language: | English |
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BMC
2021-05-01
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| Series: | BMC Gastroenterology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12876-021-01825-2 |
| _version_ | 1818600953725583360 |
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| author | Edmond Atallah Pramudi Wijayasiri Nicole Cianci Khorrum Abdullah Abhik Mukherjee Guruprasad P. Aithal |
| author_facet | Edmond Atallah Pramudi Wijayasiri Nicole Cianci Khorrum Abdullah Abhik Mukherjee Guruprasad P. Aithal |
| author_sort | Edmond Atallah |
| collection | DOAJ |
| description | Abstract Background Zanubrutinib is a Bruton’s tyrosine kinase inhibitor that has been recently licensed in refractory mantle cell lymphoma and under assessment in phase 3 clinical trials for other B cell malignancies. To date, there are no reported cases of hepatotoxicity secondary to zanubrutinib. We report the first case of severe liver injury due to zanubrutinib. Case presentation A 56-year-old Caucasian male with a history of relapsed lymphoplasmacytic lymphoma was admitted to the hospital with new-onset jaundice, choluria, and pruritus for 10 days. He had been on zanubrutinib as part of a clinical trial for 30 months. His blood profile showed a severe hepatocellular injury with jaundice (alanine transaminase 2474 IU/L and total bilirubin 141 umol/L with mild coagulopathy). He had an extensive work-up including virology, autoimmune, and metabolic profiles in addition to abdominal ultrasound with no alternative explanation found for his liver injury. Zanubrutinib-induced liver injury was suspected, and causality assessment by the updated Roussel Uclaf Causality Assessment Method score showed a probable causal relationship with zanubrutinib. His liver histology was also consistent with drug-induced liver injury. His liver biochemistry improved following cessation of zanubrutinib and normalised after 8 weeks. Conclusion We report the first case of severe liver injury secondary to zanubrutinib after 30 months of treatment. This case raises clinical awareness regarding zanubrutinib-induced liver toxicity and the importance of drug withdrawal in the event of liver injury. |
| first_indexed | 2024-12-16T12:43:41Z |
| format | Article |
| id | doaj.art-ab03c1466c7c483e9feeabf820b9bdd1 |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-16T12:43:41Z |
| publishDate | 2021-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-ab03c1466c7c483e9feeabf820b9bdd12022-12-21T22:31:21ZengBMCBMC Gastroenterology1471-230X2021-05-012111710.1186/s12876-021-01825-2Zanubrutinib-induced liver injury: a case report and literature reviewEdmond Atallah0Pramudi Wijayasiri1Nicole Cianci2Khorrum Abdullah3Abhik Mukherjee4Guruprasad P. Aithal5Nottingham Digestive Diseases Centre, School of Medicine, University of NottinghamNational Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of NottinghamUniversity Hospitals Birmingham (UHB)Histopathology, Nottingham University Hospitals NHS TrustHistopathology, Nottingham University Hospitals NHS TrustNottingham Digestive Diseases Centre, School of Medicine, University of NottinghamAbstract Background Zanubrutinib is a Bruton’s tyrosine kinase inhibitor that has been recently licensed in refractory mantle cell lymphoma and under assessment in phase 3 clinical trials for other B cell malignancies. To date, there are no reported cases of hepatotoxicity secondary to zanubrutinib. We report the first case of severe liver injury due to zanubrutinib. Case presentation A 56-year-old Caucasian male with a history of relapsed lymphoplasmacytic lymphoma was admitted to the hospital with new-onset jaundice, choluria, and pruritus for 10 days. He had been on zanubrutinib as part of a clinical trial for 30 months. His blood profile showed a severe hepatocellular injury with jaundice (alanine transaminase 2474 IU/L and total bilirubin 141 umol/L with mild coagulopathy). He had an extensive work-up including virology, autoimmune, and metabolic profiles in addition to abdominal ultrasound with no alternative explanation found for his liver injury. Zanubrutinib-induced liver injury was suspected, and causality assessment by the updated Roussel Uclaf Causality Assessment Method score showed a probable causal relationship with zanubrutinib. His liver histology was also consistent with drug-induced liver injury. His liver biochemistry improved following cessation of zanubrutinib and normalised after 8 weeks. Conclusion We report the first case of severe liver injury secondary to zanubrutinib after 30 months of treatment. This case raises clinical awareness regarding zanubrutinib-induced liver toxicity and the importance of drug withdrawal in the event of liver injury.https://doi.org/10.1186/s12876-021-01825-2ZanubrutinibhepatotoxicityDrug-induced liver injuryCase reportRUCAM |
| spellingShingle | Edmond Atallah Pramudi Wijayasiri Nicole Cianci Khorrum Abdullah Abhik Mukherjee Guruprasad P. Aithal Zanubrutinib-induced liver injury: a case report and literature review BMC Gastroenterology Zanubrutinib hepatotoxicity Drug-induced liver injury Case report RUCAM |
| title | Zanubrutinib-induced liver injury: a case report and literature review |
| title_full | Zanubrutinib-induced liver injury: a case report and literature review |
| title_fullStr | Zanubrutinib-induced liver injury: a case report and literature review |
| title_full_unstemmed | Zanubrutinib-induced liver injury: a case report and literature review |
| title_short | Zanubrutinib-induced liver injury: a case report and literature review |
| title_sort | zanubrutinib induced liver injury a case report and literature review |
| topic | Zanubrutinib hepatotoxicity Drug-induced liver injury Case report RUCAM |
| url | https://doi.org/10.1186/s12876-021-01825-2 |
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