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How I treat CLL patients With ibrutinib

Jennifer R. Brown

Abstract

Ibrutinib is a transformative therapy for high risk and relapsed refractory CLL patients. In clinical trials in relatively healthy younger patients, ibrutinib has been well tolerated. As its use has become more widespread in the community, however, its full adverse event profile has emerged and proven more challenging than initially anticipated. Reports of community-based use have estimated discontinuation rates as high as 40% in the first year of therapy. This article therefore reviews my approach to the evaluation and management of a CLL patient starting on ibrutinib, with the goal of minimizing and managing toxicity to maintain patients on ibrutinib. Key topics discussed include bleeding risk, cardiac complications particularly atrial fibrillation, drug interactions and infections.

  • Submitted August 7, 2017.
  • Accepted December 5, 2017.