Case Study Shows Success of Ibrutinib for CLL/SLL After Allo-HSCT

The introduction of novel drugs, such as ibrutinib, acalabrutinib, and venetoclax has dramatically changed the treatment landscape for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), according to Masatoshi Sakurai, MD, PhD, Assistant Professor, Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan (Ann Hematol. 2021 Jul 8. Epub ahead of print).

However, allogeneic hematopoietic stem cell transplantation (allo-HSCT) still remains as a curative treatment.

Treating CLL/SLL patients who have relapsed after receiving an allo-HSCT is generally difficult, Dr Sakurai said. There are also no current standard treatment options available for patients with CLL/SLL who have central nervous system involvement (CNSi) or relapse after allo-HSCT, Dr Sakurai said.

Thus, Dr Sakurai, shared a case study with Oncology Learning Network on the successful use of ibrutinib in a patient with CLL/SLL who had CNS relapse approximately 10 years after receiving an allo-HSCT.

“The patient complained of back pain and bilateral lower extremities numbness followed by gait disturbance and bladder and bowel dysfunction. Spinal magnetic resonance imaging (MRI) revealed a thoracic spine mass, and biopsy of the mass revealed proliferation of small- to middle-sized mononuclear cells expressing CD5, CD20 and CD23. Therefore, he was diagnosed with relapse of CLL/SLL,” Dr Sakurai said.

The patient then received ibrutinib 420mg/day.

Dr Sakurai said he saw a significant clinical response after the initial treatment. In addition, a decrease in the size of the thoracic spine mass was confirmed by MRI 2 months after the start of the treatment.

“To our best knowledge, this is the first case in which ibrutinib was effective as salvage therapy in a CLL/SLL patient who had CNSi after allo-HSCT,” Dr Sakurai continued.

With a limited number of drugs available effective against CNSi, Dr Sakurai said, it is expected that ibrutinib will be effective against CNSi and other leukemias and lymphomas.

“The number of patients with CNSi is limited, and further accumulation of cases by many researchers is needed,” he said.

In conclusion, Dr Sakurai suggested ibrutinib is not only effective for CNSi, but also enhances the graft-versus-leukemia effect, and thus is considered a reasonable treatment option for post-HSCT.