Use of Ibrutinib During COVID-19–Induced Respiratory Failure in CLL: Case Study
Posted: Monday, November 23, 2020
A case report published in eJHaem (the online version of record before inclusion in the European Journal of Haematology) described the outcome of continued ibrutinib treatment in a patient with chronic lymphocytic leukemia (CLL) who had been intubated due to severe COVID-19 infection. Leo I. Gordon, MD, of Northwestern University, Chicago, and colleagues noted that the tyrosine kinase inhibitor is considered an immunosuppressant whose use in patients with an active infection is controversial.
The 73-year-old patient was diagnosed with CLL in 2005; he began receiving 420 mg of daily ibrutinib in 2016 after and had been stable since then. In March 2020, the patient presented with 4 days of dry cough, fever up to 101°F, and sore throat without shortness of breath. A COVID-19 test was not performed because a strep throat antigen swab was positive. Subsequently, the patient presented to an emergency room with an oxygen saturation level of 89%. A COVID-19 nasal test was positive; the patient was admitted, and ibrutinib therapy was discontinued.
The patient was intubated on his second day in the intensive care unit due to progressive acute hypoxemic respiratory failure. Ibrutinib therapy was reinstated at an increased dose of 560 mg daily. The patient also received a single dose of hydroxychloroquine and two doses of tocilizumab on the fifth and sixth days due to persistent fever. Following an improvement in his condition, the patient was extubated and resumed his previous daily dose of 420 mg of imatinib.
“We elected to continue ibrutinib the same day he was intubated, reasoning that [Bruton’s tyrosine kinase] inhibition in myeloid immune cells has been shown to reduce or even reverse influenza‐mediated acute lung injury and that [interleukin-2 inducible T-cell kinase] inhibition in T cells has correlated with reduction in viral replication, and therefore may have an advantage in this setting,” the authors explained.
Disclosure: The study authors reported no conflicts of interest.