Ibrutinib-associated tumor Lysis syndrome in a patient with chronic lymphocytic Leukemia

摘要

Ibrutinib is a potent inhibitor of Bruton tyrosine kinase with promising efficacy in chronic lymphocytic leukemia (CLL). It is well tolerated, and grade 3/4 adverse events are infrequent (12%). Lymphocytosis has been reported in-70% of patients receiving ibrutinib. Such lymphocytosis is usually asymptomatic and has no clinical consequence for the patient. We describe a patient who developed tumor lysis syndrome (TLS) with ibrutinib monotherapy. A 57-year-old man was initially diagnosed with Rai stage II CLL in 2004. A bone marrow biopsy at diagnosis showed 30% to 35% interstitial and focally diffuse involvement. Neoplastic cells were dim positive for CD79b, but were negative for CD 10 and FMC7. Fluorescent in situ hybridization showed deletion of chromosome 11q22 (27.5% nuclei); however, there was no evidence of 17pl3 deletion, 13q14 deletion, or tri-somyl2. Immunoglobulin heavy chain variable region (IGHV) somatic hypermutation analysis was negative for IGHV VH2-5 gene mutation.