Ibrutinib effect in acquired von Willebrand syndrome secondary to Waldenström macroglobulinemia

The pathological increase of clonal IgM in Waldenström macroglobulinemia can be associated with acquired von Willebrand syndrome and can be a major risk of bleeding symptoms in this subgroup of patients with Waldenström macroglobulinemia. The Bruton tyrosine kinase inhibitor ibrutinib is one of the...

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Main Authors: María Poza, Rodrigo Íñiguez, Irene Zamanillo, Sara Redondo, Rafael Alonso, Joaquín Martínez-López, Ana Jiménez-Ubieto
Format: Article
Language:English
Published: SAGE Publishing 2021-08-01
Series:Therapeutic Advances in Hematology
Online Access:https://doi.org/10.1177/20406207211039326
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author María Poza
Rodrigo Íñiguez
Irene Zamanillo
Sara Redondo
Rafael Alonso
Joaquín Martínez-López
Ana Jiménez-Ubieto
author_facet María Poza
Rodrigo Íñiguez
Irene Zamanillo
Sara Redondo
Rafael Alonso
Joaquín Martínez-López
Ana Jiménez-Ubieto
author_sort María Poza
collection DOAJ
description The pathological increase of clonal IgM in Waldenström macroglobulinemia can be associated with acquired von Willebrand syndrome and can be a major risk of bleeding symptoms in this subgroup of patients with Waldenström macroglobulinemia. The Bruton tyrosine kinase inhibitor ibrutinib is one of the approved treatments for symptomatic Waldenström macroglobulinemia. However, some controversy exists regarding the use of ibrutinib in these patients with high risk of bleeding because of its antiaggregant effect that could increase the risk of bleeding. Here, we present the case of a patient with Waldenström macroglobulinemia with associated acquired von Willebrand syndrome and progressively significant bleeding symptoms, who experienced a rapid increase in von Willebrand factor with ibrutinib treatment, despite only reaching a partial response in IgM levels similar to those reached with other previous treatments. We suggest that the control over the monoclonal protein is not the only mechanism that explains the good response, improvement in the bleeding symptoms and von Willebrand factor levels. This fact could be explained by the reduced glycoprotein Ib receptor expression induced by ibrutinib and the consequent von Willebrand factor increase in peripheral blood.
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spelling doaj.art-cbb3befc6d664c8a9d79c5cf541c22a62022-12-21T20:02:53ZengSAGE PublishingTherapeutic Advances in Hematology2040-62152021-08-011210.1177/20406207211039326Ibrutinib effect in acquired von Willebrand syndrome secondary to Waldenström macroglobulinemiaMaría PozaRodrigo ÍñiguezIrene ZamanilloSara RedondoRafael AlonsoJoaquín Martínez-LópezAna Jiménez-UbietoThe pathological increase of clonal IgM in Waldenström macroglobulinemia can be associated with acquired von Willebrand syndrome and can be a major risk of bleeding symptoms in this subgroup of patients with Waldenström macroglobulinemia. The Bruton tyrosine kinase inhibitor ibrutinib is one of the approved treatments for symptomatic Waldenström macroglobulinemia. However, some controversy exists regarding the use of ibrutinib in these patients with high risk of bleeding because of its antiaggregant effect that could increase the risk of bleeding. Here, we present the case of a patient with Waldenström macroglobulinemia with associated acquired von Willebrand syndrome and progressively significant bleeding symptoms, who experienced a rapid increase in von Willebrand factor with ibrutinib treatment, despite only reaching a partial response in IgM levels similar to those reached with other previous treatments. We suggest that the control over the monoclonal protein is not the only mechanism that explains the good response, improvement in the bleeding symptoms and von Willebrand factor levels. This fact could be explained by the reduced glycoprotein Ib receptor expression induced by ibrutinib and the consequent von Willebrand factor increase in peripheral blood.https://doi.org/10.1177/20406207211039326
spellingShingle María Poza
Rodrigo Íñiguez
Irene Zamanillo
Sara Redondo
Rafael Alonso
Joaquín Martínez-López
Ana Jiménez-Ubieto
Ibrutinib effect in acquired von Willebrand syndrome secondary to Waldenström macroglobulinemia
Therapeutic Advances in Hematology
title Ibrutinib effect in acquired von Willebrand syndrome secondary to Waldenström macroglobulinemia
title_full Ibrutinib effect in acquired von Willebrand syndrome secondary to Waldenström macroglobulinemia
title_fullStr Ibrutinib effect in acquired von Willebrand syndrome secondary to Waldenström macroglobulinemia
title_full_unstemmed Ibrutinib effect in acquired von Willebrand syndrome secondary to Waldenström macroglobulinemia
title_short Ibrutinib effect in acquired von Willebrand syndrome secondary to Waldenström macroglobulinemia
title_sort ibrutinib effect in acquired von willebrand syndrome secondary to waldenstrom macroglobulinemia
url https://doi.org/10.1177/20406207211039326
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