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Case Study in CLL Features Ibrutinib-Induced Cardiac Tamponade

By: Joshua D. Madera, MS
Posted: Thursday, January 28, 2021

Treatment with Bruton’s tyrosine kinase inhibitor ibrutinib may have led to the development of cardiac tamponade and atrial fibrillation in a patient with chronic lymphocytic leukemia (CLL), based on a letter to the editor published in the Turkish Journal of Haematology. Thus, physicians should be aware of the additional precautions necessary should similar patients experience palpitations and dyspnea, suggested Shinya Kimura, MD, PhD, of Saga University Hospital, Japan, and colleagues.

The patient was a 70-year-old woman who presented with complaints of dyspnea and malaise. Her medical history was significant for CLL, diagnosed 12 years ago, which was treated with cyclophosphamide monotherapy. As a result of disease progression, she began ibrutinib monotherapy.

Physical examination revealed an increased respiratory rate, decreased systolic blood pressure, prominent venous jugular distention, and muffled cardiac sounds. Further analysis of the complete blood cell count revealed leukocytosis with abnormal lymphocytes, polycythemia, and thrombocytosis. However, assessment of coagulation tests demonstrated normal levels of prothrombin time international normalized ratio and partial thromboplastin time.

These findings prompted an electrocardiogram, which revealed atrial fibrillation with decreased QRS voltage. Furthermore, cardiomegaly was identified on chest x-ray, and a large pericardial effusion with right ventricular collapse was identified on transthoracic echocardiography. The physicians concluded these findings were consistent with cardiac tamponade.

To alleviate her condition, pericardiocentesis was performed, and the fluid drained was analyzed. Examination of the fluid revealed decreased protein levels, increased lactate dehydrogenase, and leukocytosis. Moreover, the leukocytes were positive for biomarker CD5, CD19, and CD23. The health-care team decided to discontinue ibrutinib therapy, which resulted in the resolution of her symptoms.

Disclosure: For full disclosures of the study authors, visit jag.journalagent.com.



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