Ibrutinib withdrawal symptoms in patients with Waldenström macroglobulinemia

Ibrutinib monotherapy outside of clinical trial setting in Waldenström macroglobulinaemia: practice patterns, toxicities and outcomes

“…The data pertaining to abrupt increase of IgM in patients with WM following discontinuation of ibrutinib are limited, with previously reported rates between 20% and 70% (Castillo et al , ; Gustine et al , ); in our cohort IgM rebound was noted within that wide range at 36%.Worsening of the disease status following ibrutinib discontinuation has also been reported in patients with chronic lymphocytic leukaemia, with an incidence of 25% (Hampel et al , ). In our study, with the exception of one patient in whom the IgM rebound resulted in symptomatic hyperviscosity, necessitating therapeutic plasmapheresis, no major clinical consequences were observed from this phenomenon.…”

How I treat Waldenström macroglobulinemia

“…Ibrutinib is associated with a risk for atrial fibrillation (in ;10% to 12% of patients) 64 and hemorrhages (usually minor, but risk increases with anticoagulants), has several interactions with commonly used drugs (antibiotics, antiarrhythmics, etc), and requires continuous uninterrupted therapy. An ibrutinib withdrawal syndrome can occur, characterized by B symptoms and IgM rebound in ;20% of patients that interrupt ibrutinib for unrelated reasons 66,67 ; however, most patients recover on reinitiation and eventually reachieve IgM response. 67 Two new BTK inhibitors are tested in WM in phase 2 (acalabrutinib) or phase 3 (zanabrutinib compared with ibrutinib) studies.…”

Pseudo‐Richter transformation of chronic lymphocytic leukaemia/small lymphocytic lymphoma following ibrutinib interruption: a diagnostic pitfall

“…Response was regained within three months of ibrutinib reinitiation. 4 No pathology results were reported in these studies. It is unclear why some patients experience withdrawal-induced progression.…”