CNS Aspergillosis After Ibrutinib Treatment for CLL: A Case Study
Posted: Thursday, February 20, 2020
Although ibrutinib has shown substantial success among patients with chronic lymphocytic leukemia (CLL), there is a growing body of evidence linking it to invasive fungal infections. Emily M. Eichenberger, MD, of Duke University, Durham, North Carolina, and colleagues researched a case of aspergillosis of the central nervous system (CNS) in a patient with CLL. The report, published in Medical Mycology Case Reports, discussed previous cases of invasive aspergillosis in patients receiving ibrutinib, its pathogenesis, and potential prophylaxis for infection.
The research team presented a case of aspergillosis of the CNS in a treatment-naive man with CLL aged 62. He had begun ibrutinib less than 1 month prior to the diagnosis.
After the diagnosis, the researchers immediately stopped ibrutinib treatment and began voriconazole therapy and combination echinocandin antifungal therapy. They did not use ibrutinib for the duration of his antifungal treatment. Fortunately, the patient achieved an excellent response with no signs of residual infection; however, the general mortality rates are 52% to 69% for patients treated with ibrutinib who develop CNS aspergillosis.
The researchers stated that the CNS may be infected through hematogenous dissemination or direct extension. CNS infections are relatively uncommon in patients with invasive aspergillosis, occurring in between 2.7% and 6% of cases. However, among those who receive ibrutinib, approximately 40% of invasive aspergillosis cases involve the CNS. This dichotomy may be due to ibrutinib-affected macrophages that transmit the fungal spores across the blood-brain barrier and allow the infection to establish in the CNS.
“Further research is needed to understand the neural disposition of invasive aspergillosis in patients treated with ibrutinib,” the study team concluded.
Disclosure: For full disclosures of the study authors, visit sciencedirect.com.
