Ibrutinib in previously treated chronic lymphocytic leukemia patients with autoimmune cytopenias in the RESONATE study

Guideline for the treatment of chronic lymphocytic leukaemia

“…RCD (rituximab, cyclophosphamide and dexamethasone), alemtuzumab or BCRi are effective alternatives for the treatment of patients who experienced therapy‐induced AIHA (Karlsson et al , ; Kaufman et al , ). A low incidence of treatment‐emergent AIHA has been reported for ibrutinib in the RESONATE front‐line study and also in a large series from Ohio (Rogers et al , ; Montillo et al , ). Anecdotal case reports of concomitant AIHA and progressive CLL also show positive results with ibrutinib +/− steroids (Molica & Polliack, ).…”

Worsening Autoimmune Neutropenia After Stopping Ibrutinib in a Patient With Chronic Lymphocytic Leukemia: Case Report and Review of Literature

“…8 In the phase 3 RESONATE-1 study, which compared ibrutinib vs. ofatumumab in previously treated CLL/SLL patients, ibrutinib did not precipitate recurrent AICs in patients with CLL who had a history of autoimmune complications. 9 In fact, ibrutinib may play a therapeutic role in the prevention and treatment of AICs in patients with CLL. 10 This was illustrated in one retrospective study Figure 1.…”

How I treat CLL patients with ibrutinib

“…Ibrutinib is thought to have the potential to control autoimmunity because of its activity in a rheumatoid arthritis mouse model 54 , and because it decreases differentiation of Th17 T cells 42 and normalizes expanded CD8 T cell compartments 54 in patients. Multiple case reports demonstrate ibrutinib effectively controlling steroid refractory AIHA 55,56 , and a report from the RESONATE trial 57 supports safe administration of ibrutinib with suggestion of enhanced control of autoimmunity. Another study reported acute flare of autoimmunity right after ibrutinib initiation, with longer term control in patients maintained on ibrutinib 58 .…”