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Reinstatement of HBV Infection After Ibrutinib Treatment in CLL: Case Study

By: Justine Landin, PhD
Posted: Wednesday, January 5, 2022

Treatment with the tyrosine kinase inhibitor ibrutinib for chronic lymphocytic leukemia (CLL) may reactivate cases of hepatitis B, according to the findings from a case study by Geir Erland Tjønnfjord, MD, of Oslo University Hospital, Norway, and colleagues. Ibrutinib treatment for CLL was paused after detection of elevated hepatitis B virus (HBV) DNA levels. Subsequent antiviral therapy rapidly improved clinical symptoms, and thus ibrutinib treatment was reinstated. The details of this case presentation were published in the journal Case Reports in Hematology.

“Our case report demonstrates that systematic HBV screening is essential before starting treatment with ibrutinib. We suggest that antiviral prophylaxis is considered for patients at risk of reactivation, and ibrutinib may be continued following HBV reactivation with proper antiviral treatment,” stated the study investigators.

A 53-year-old woman with no history of hepatitis presented with swelling of both parotic glands. She was not diagnosed with CLL until 7 years later; a whole-body CT scan revealed generalized lymphadenopathy, and CLL was confirmed by flow cytometry.

First-line treatment included six courses of fludarabine, cyclophosphamide, and rituximab. It appeared that the patient achieved complete remission until a CLL relapse 5 years later. One course of chemotherapy had no effect, and genetic analysis showed homozygous deletion of 13q14 and heterozygous TP53 mutation, which led to initiation of ibrutinib therapy (420 mg/day).

Approximately 6 months later, the patient was admitted due to malaise, fever, jaundice, and elevated liver parameters. An initial diagnosis of obstructive uropathy with septicemia or biliary obstruction led to administration of piperacillin and tazobactam. However, a CT scan indicated no evidence of septicemia and led to a diagnosis of hepatitis, which was confirmed via polymerase chain reaction. Ibrutinib therapy was paused and tenofovir administered until improvement in clinical outcomes was observed 1 month later. For several years, the patient was in remission until CLL relapse and died of septicemia 1 year later.

Disclosure: The study authors reported no conflicts of interest.



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