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Ibrutinib for chronic graft-versus-host disease after failure of prior therapy

David Miklos, Corey S. Cutler, Mukta Arora, Edmund K. Waller, Madan Jagasia, Iskra Pusic, Mary E. Flowers, Aaron C. Logan, Ryotaro Nakamura, Bruce R. Blazar, Yunfeng Li, Stephen Chang, Indu Lal, Jason Dubovsky, Danelle F. James, Lori Styles and Samantha Jaglowski

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  • RE: Ibrutinib and graft-versus-host disease after allogeneic stem cell transplantation
    • Issa F. Khouri, MD The University of Texas MD Anderson Cancer Center, Houston, Texas
    • Other Contributors:
      • Elias J. Jabbour, MD
      • Alison M. Gulbis, MD

     

    Miklos and colleagues reported a therapeutic response rate of 67% for ibrutinib in 42 patients who had chronic graft-versus-host disease (GVHD) after allogeneic stem cell transplantation (alloSCT).1 Concomitant use of other immunosuppressive therapies including extracorporeal photopheresis was permitted. Seven of 10 patients who were previously treated with rituximab responded to ibrutinib.

    We retrospectively reviewed the outcomes in 22 patients with CLL or mantle cell lymphoma who experienced relapses after non-myeloablative (n=17) or ablative (n=5) alloSCT from December 1, 2011, to December 1, 2014, and then received ibrutinib.2 This study was approved by the institutional review board at our center. The patients’ median age was 63 years.  The median time from progression after alloSCT to starting treatment with ibrutinib was 17 months (range, 0.5-88.0). At the time of ibrutinib initiation, none of the patients were receiving immunosuppressive therapy. The ibrutinib dose ranged from 420 to 560 mg daily. During a median follow-up time of 15 months (range, 4-38), three patients (14%) progressed to moderate or severe chronic GVHD after initiating ibrutinib, and one (5%) developed  acute grade 4 GVHD causing death. All four of these patients had mild chronic GVHD prior to initiation of ibrutinib. In addition, we observed 10 episodes of grade 2 infection and 1 of septic shock during the course of treatment. One pa...

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    Conflict of Interest:
    None declared.