Chronic Lymphocytic Leukemia Coverage from Every Angle

BTK Inhibitor and Cerebral Invasive Aspergillosis: Case Report in CLL

By: Joshua D. Madera, MS
Posted: Thursday, March 25, 2021

For patients with chronic lymphocytic leukemia (CLl), treatment with the Bruton’s tyrosine kinase inhibitor acalabrutinib may increase their susceptibility to infection with Aspergillus, according to a case report published in Current Oncology. “We believe that the risk of invasive fungal infection results from a class effect rather than ibrutinib alone,” explained Amitkumar Mehta, MD, of the O’Neal Comprehensive Cancer Center, Birmingham, Alabama, and colleagues.

The patient was a 62-year-old man who presented with fatigue, weight loss, and cervical lymphadenopathy. A complete blood cell count revealed thrombocytopenia and anemia. Further analysis with CT scan revealed splenomegaly accompanied by enlarged supra- and infradiaphragmatic lymph nodes. An excisional lymph node biopsy was performed and showed B cells expressing CD5, CD19, CD20, CD23, and CD38. These findings were consistent with B-cell lymphoproliferative CLL.

Based on these findings, the decision was made to start the patient on combination acalabrutinib and obinutuzumab. After his third treatment cycle, the patient began experiencing episodes of slurred speech and confusion. MRI of the brain revealed a 2.4 cm x 1.7 cm x 1.7 cm mass in the left temporal lobe. Biopsy of his brain mass revealed gliosis with macrophage infiltration and microglial activation. To prevent leukoencephalopathy, the decision was made to discontinue obinutuzumab therapy and restart acalabrutinib therapy. However, repeat MRI 3 weeks later demonstrated progression of the temporal lesion and a diagnosis of infection with Aspergillus fumigatus was confirmed. Following treatment with amphotericin B and isavuconazonium, the patient’s condition significantly improved.

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