COVID-19 in a Patient With CLL Being Treated With Ibrutinib
Posted: Thursday, November 18, 2021
According to a case report presented as a letter to the editor in the journal Blood Research, patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) who contract COVID-19 may exhibit changes in the biologic behavior of the hematologic malignancy that could modify their response to specific drugs such as Bruton’s tyrosine kinase (BTK) BTK inhibitors such as ibrutinib. According to Otávio Cesar Carvalho Guimarães Baiocchi, PhD, of the Department of Clinical and Experimental Oncology, Federal University of São Paulo, and colleagues, the potential immunopathologic complications associated with the coronavirus warrant attention in this patient population.
The authors described the case of a 68-year-old man with stage 4 refractory CLL or SLL undergoing ibrutinib treatment who tested positive for COVID-19. The patient was initially treated with chemotherapy and immunotherapy before beginning a course of ibrutinib, to which the patient responded favorably.
Two months later, the patient reported to the hospital with fever, fatigue, and a productive cough. Bloodwork and CT imaging confirmed bacterial community-acquired pneumonia, for which he received clavulanate potassium and azithromycin. Shortly thereafter, he returned to the emergency department with hypotension and decreased consciousness. Ibrutinib therapy was stopped, and COVID-19 was confirmed.
After two subsequent hospital stays, ibrutinib was resumed, with no response. After 1 month, a bone marrow biopsy revealed 95% infiltration by lymphoid cells. Then, the patient experienced severe anemia as well as reduced consciousness and oxygen saturation, which resulted in death.
The authors are unable to explain why the patient became resistant to ibrutinib but note that temporary dose interruption for viral infection could lead to rapid disease progression and may affect survival outcomes. The authors concluded that although ibrutinib may protect against lung injury in patients with these hematologic malignancies who also have COVID-19, more research on the effects of BTK inhibitors on tumor behavior is needed.
Disclosure: The authors reported no conflicts of interest.
