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Benkhadra M, Fituri N, Aboukhalaf S, Ghasoub R, Mattar M, Alfarsi K, Alshemmari S, Yassin MA. The Safety of Novel Therapies in Chronic Lymphocytic Leukemia in the Era of Intermittent Fasting: A Pharmacology-Based Review. Cancers (Basel) 2024; 16:2079. [PMID: 38893198 PMCID: PMC11171109 DOI: 10.3390/cancers16112079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 06/21/2024] Open
Abstract
Intermittent fasting (IF) has recently gained popularity due to its emerging benefits in reducing weight and improving metabolic health. Concurrently, novel agents (NAs) like venetoclax and Bruton tyrosine kinase inhibitors (BTKIs) have revolutionized the treatment of chronic lymphocytic leukemia (CLL). Unfortunately, it is unclear whether the associated risks of tumor lysis syndrome (TLS) and gastrointestinal bleeding (GIB) are increased in IF practitioners receiving NAs. This review explored the literature available on the permissibility of IF in CLL patients undergoing treatment with first-line NAs (FLNAs). Literature was scoped to identify IF patterns and the available data on TLS and GIB risks associated with food and fluid intake in CLL patients receiving FLNAs. Although current evidence is insufficient to recommend IF in this population, it may be possible for patients on venetoclax to conservatively practice fluid-liberal IF, provided that adequate hydration and the consistent administration of food are achieved. In contrast, considering the significant risk of TLS and the pharmacokinetics of venetoclax, patients should be discouraged from practicing fluid-restricted IF, especially during the ramp-up phase. Moreover, patients on BTKIs ought to refrain from IF due to the possible risk of GIB until further data are available. Further research is needed to provide conclusive recommendations.
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Affiliation(s)
- Maria Benkhadra
- Department of Pharmacy, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
| | - Nuha Fituri
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (N.F.); (S.A.)
| | - Soha Aboukhalaf
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (N.F.); (S.A.)
| | - Rola Ghasoub
- Department of Pharmacy, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
| | - Mervat Mattar
- Clinical Hematology Unit, Internal Medicine Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo 12111, Egypt;
| | - Khalil Alfarsi
- Department of Hematology, Sultan Qaboos University Hospital Muscat, Seeb P.O. Box 35, Oman;
| | - Salem Alshemmari
- Department of Medicine, Faculty of Medicine and Department of Hematology, Kuwait Cancer Control Centre, Shuwaikh P.O. Box 42262, Kuwait;
| | - Mohamed A. Yassin
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar; (N.F.); (S.A.)
- Department of BMT/Hematology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
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Ammad Ud Din M, Thakkar S, Patel H, Saeed H, Hussain SA, Liaqat H, Zafar A, Dani SS, Ganatra S, Anwer F. The Impact of Atrial Fibrillation on hospitalization Outcomes for Patients With Chronic Lymphocytic Leukemia Using the National Inpatient Sample Database. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2021; 22:98-104. [PMID: 34598909 DOI: 10.1016/j.clml.2021.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/15/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The incidence of atrial fibrillation (AF) in patients with chronic lymphocytic leukemia (CLL) has been on the rise. However, the excess burden added by AF to the morbidity and mortality of CLL patients especially in the hospitalized setting is undetermined. METHODS The National Inpatient Sample (NIS) database was accessed to gather data of hospitalized CLL patients with AF from 2009 to 2018. Propensity-score matching (PSM) and logistic regression model were performed to control for baseline patient factors to match 7265 CLL patient admissions with AF and 7265 CLL patient admissions without AF. The primary outcome was all-cause mortality (ACM), while the secondary outcomes included acute coronary syndrome (ACS), acute myocardial infarction (AMI), and the need for percutaneous coronary intervention (PCI), acute heart failure (AHF), acute hypoxic respiratory failure (AHRF), cardiac arrest (CA), cardiogenic shock (CS), stroke, and the total cost of hospitalization. RESULTS CLL patients with AF had a higher rate of ACM (6.06% vs 4.47%; odds ratio [OR] 1.39, 95% confidence interval [CI] 1.19-1.61; P =< .001). All other secondary outcomes including ACS, AMI, PCI, AHRF, CA, CS, and stroke were observed at a significantly higher rate in the AF group as well. The median total hospital cost was also higher in the AF group ($9097 vs. $7646; P value < .0001) CONCLUSION: CLL patients with AF are at a significantly increased risk of all-cause mortality, cardiac-related mortality, and stroke. For this population, a multidisciplinary approach should be orchestrated for better management and outcomes.
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Affiliation(s)
| | | | - Harsh Patel
- Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, IL
| | - Hassan Saeed
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Syed Ather Hussain
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Hania Liaqat
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Aneeqa Zafar
- Department of Hospitalist Medicine, El Camino Health Mountain View Campus, Mountain View, CA
| | - Sourbha S Dani
- Department of Cardiology, Lahey Hospital & Medical Center, MA
| | - Sarju Ganatra
- Department of Cardiology, Lahey Hospital & Medical Center, MA
| | - Faiz Anwer
- Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
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Baral B, Ahuja K, Chhabra N, Tariq MJ, Zia M. Life-Threatening Fungal Infection in Richter Transformation of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: A Case Report and Brief Review of Literature. Cureus 2021; 13:e15924. [PMID: 34277298 PMCID: PMC8285100 DOI: 10.7759/cureus.15924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 11/05/2022] Open
Abstract
Chronic lymphocytic leukemia/small lymphocytic lymphoma is an indolent B cell lymphoproliferative malignancy typically affecting the elderly. Clinical outcomes of this condition have steadily improved as a result of advances in therapy. However, an increase in survival is accompanied by increased incidence of Richter transformation into an aggressive lymphoma. We present one such case and delve into its risk factors and associated complications. Exposure to increased lines of treatment appears to be a contributing factor in transformation, such that those with fewer than two lines of treatment are considered to have a lower risk of transformation. Fever, rapid lymph node involvement and drastic increases in lactate dehydrogenase, as seen in our patient, are concerning for transformation and treatment options include chemotherapy versus novel agent therapy. However, patients receiving therapy are at risk for adverse outcomes such as invasive infections, particularly in those receiving consolidation chemotherapy. Fungal infections such as Aspergillus and Candida are gaining prominence in the setting of neutropenia which adversely impact survival, but are underreported. Efforts to improve outcomes may include consideration of growth factor therapy in neutropenic patients and continuing to be vigilant for early signs of infection.
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Affiliation(s)
- Binav Baral
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Kriti Ahuja
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Navika Chhabra
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Muhammad J Tariq
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
- Hematology and Oncology, University of Arizona, Tucson, USA
| | - Maryam Zia
- Hematology and Medical Oncology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
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Popov VM, Matei CO, Omer M, Onisai M, Matei MB, Savopol T, Bumbea H, Moisescu MG. Effects of Ibrutinib on biophysical parameters of platelet in patients with chronic lymphocytic leukaemia. AMERICAN JOURNAL OF BLOOD RESEARCH 2020; 10:311-319. [PMID: 33489439 PMCID: PMC7811905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/14/2020] [Indexed: 06/12/2023]
Abstract
Patients with chronic lymphocytic leukemia (CLL) treated with Ibrutinib often present hemorrhagic complications. Platelets dysfunction is well documented by aggregometry and flow cytometry, but the mechanisms by which Ibrutinib treatment influences the platelets status is yet to be evaluated. The aim of this study is to identify platelet membrane parameters in chronic lymphocytic leukemia (CLL) that could be altered by Ibrutinib administration. In this paper we propose a set of fluorescence measurements of the following parameters: membrane fluidity, resting membrane potential, and reactive oxygen species production of platelets suspensions obtained from CLL patients treated or not with Ibrutinib as markers for platelets status in this pathological situation. Platelets from CLL patients treated with Ibrutinib have higher membrane fluidity, lower resting membrane potential and higher level of reactive oxygen species production compared to the untreated CLL patients. These patients are also presenting higher membrane fluidity and lower resting membrane potential compared to healthy volunteers.
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Affiliation(s)
- Viola Maria Popov
- Hematology Department, Colentina Clinical Hospital19-21 Stefan cel Mare Road, Bucharest 020125, Romania
| | - Christien Oktaviani Matei
- Biophysics and Cellular Biotechnology Department, Carol Davila University of Medicine and Pharmacy8 Eroii Sanitari Boulevard, Bucharest 050474, Romania
- Excellence Centre for Research in Biophysics and Cellular Biotechnology, Carol Davila University of Medicine and Pharmacy8 Eroii Sanitari Boulevard, Bucharest 050474, Romania
| | - Meilin Omer
- Hematology Department, Colentina Clinical Hospital19-21 Stefan cel Mare Road, Bucharest 020125, Romania
| | - Minodora Onisai
- Hematology Department, University Emergency Hospital169 Splaiul Independentei, Bucharest 050098, Romania
| | - Mircea Bogdan Matei
- Biophysics and Cellular Biotechnology Department, Carol Davila University of Medicine and Pharmacy8 Eroii Sanitari Boulevard, Bucharest 050474, Romania
- Excellence Centre for Research in Biophysics and Cellular Biotechnology, Carol Davila University of Medicine and Pharmacy8 Eroii Sanitari Boulevard, Bucharest 050474, Romania
| | - Tudor Savopol
- Biophysics and Cellular Biotechnology Department, Carol Davila University of Medicine and Pharmacy8 Eroii Sanitari Boulevard, Bucharest 050474, Romania
- Excellence Centre for Research in Biophysics and Cellular Biotechnology, Carol Davila University of Medicine and Pharmacy8 Eroii Sanitari Boulevard, Bucharest 050474, Romania
| | - Horia Bumbea
- Hematology Department, University Emergency Hospital169 Splaiul Independentei, Bucharest 050098, Romania
| | - Mihaela G Moisescu
- Biophysics and Cellular Biotechnology Department, Carol Davila University of Medicine and Pharmacy8 Eroii Sanitari Boulevard, Bucharest 050474, Romania
- Excellence Centre for Research in Biophysics and Cellular Biotechnology, Carol Davila University of Medicine and Pharmacy8 Eroii Sanitari Boulevard, Bucharest 050474, Romania
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Dmitrieva EA, Nikitin EA, Ignatova AA, Vorobyev VI, Poletaev AV, Seregina EA, Voronin KA, Polokhov DM, Maschan AA, Novichkova GA, Panteleev MA, Ptushkin VV. Platelet function and bleeding in chronic lymphocytic leukemia and mantle cell lymphoma patients on ibrutinib. J Thromb Haemost 2020; 18:2672-2684. [PMID: 32511880 DOI: 10.1111/jth.14943] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Therapy with irreversible Bruton's tyrosine kinase inhibitor ibrutinib in chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL) is associated with bleeding. OBJECTIVES To propose the predictive markers of such bleeding, as well as mechanisms responsible for decreased bleeding at later therapy stages. PATIENTS/METHODS We investigate platelet functional activity in 50 CLL and 16 MCL patients on ibrutinib using flow cytometry and light transmission aggregometry. RESULTS Prior to treatment, both patient groups had decreased platelet counts; impaired aggregation with adenosine diphosphate (ADP); and decreased binding of CD62P, PAC1, and annexin V upon stimulation. Bleeding in patients treated with ibrutinib was observed in 28 (56%) CLL patients, who had decreased aggregation with ADP and platelet count before therapy. Their platelet count on therapy did not change, platelet aggregation with ADP steadily improved, and aggregation with collagen first decreased and then increased in anticorrellation with bleeding. Bleeding in MCL was observed in 10 (62%) patients, who had decreased dense granule release before therapy. ADP and ristocetin induced platelet aggregation in ibrutinib-treated MCL patients increased on therapy, while collagen-induced aggregation evolved similarly to CLL patients. CONCLUSIONS Our results suggest that ibrutinib-dependent bleeding in CLL patients involves three mechanisms: decreased platelet count (the most important discriminator between bleeding and non-bleeding patients), impaired platelet response to ADP caused by CLL, and inhibition by ibrutinib. Initially, ibrutinib shifts the balance to bleeding, but then it is restored because of the improved response to ADP.
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Affiliation(s)
| | | | - Anastasia A Ignatova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry of the Russian Academy of Sciences, Moscow, Russia
| | | | - Aleksandr V Poletaev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Elena A Seregina
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Kirill A Voronin
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Dmitry M Polokhov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Aleksey A Maschan
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Galina A Novichkova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Mikhail A Panteleev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physicochemical Pharmacology of the Russian Academy of Sciences, Moscow, Russia
- Faculty of Physics, Lomonosov Moscow State University, Moscow, Russia
- Faculty of Biological and Medical Physics, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
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Georgantopoulos P, Yang H, Norris LB, Bennett CL. Major hemorrhage in chronic lymphocytic leukemia patients in the US Veterans Health Administration system in the pre-ibrutinib era: Incidence and risk factors. Cancer Med 2019; 8:2233-2240. [PMID: 30983123 PMCID: PMC6536934 DOI: 10.1002/cam4.2134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 03/04/2019] [Accepted: 03/15/2019] [Indexed: 12/03/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) patients are at increased risk for major hemorrhage (MH). We examined incidence of and risk factors for MH in CLL patients before introduction of newer CLL therapies such as ibrutinib, which includes bleeding risk. This study included 24 198 CLL patients treated in the VA system before FDA approval of ibrutinib as CLL therapy. Data came from VA databases from 1999 to 2013. MH incidence was 1.9/100 person-years (95% CI: 1.8-1.9), with cumulative incidences of 2.3%, 5.2%, and 7.3% by year 1, 3, and 5, respectively. Median time from CLL diagnosis to MH was 2.8 years (range: 0-15.7 years). In multivariate analyses, concurrent anticoagulant and antiplatelet use (HR: 4.2; 95% CI: 3.2-5.6), anticoagulant use only (HR: 2.6; 95% CI: 2.3-3.1), and antiplatelet use only (HR: 1.5; 95% CI: 1.3-1.7) increased MH risk vs not receiving those medications; being nonwhite, male, having MH history, renal impairment, anemia, thrombocytopenia, and alcohol abuse were associated with increased MH risk. These pre-ibrutinib data are important for providing context for interpreting MH risk in ibrutinib-treated patients. As ibrutinib clinical use is increasing, updated analyses of MH risk among ibrutinib-treated VA patients with CLL may provide additional useful insight.
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Affiliation(s)
- Peter Georgantopoulos
- William Jennings Bryan Dorn Veterans Affairs Medical CenterColumbiaSouth Carolina
- Southern Network on Adverse Reactions (SONAR), South Carolina Center of Economic Excellence for Medication Safety, College of PharmacyUniversity of South CarolinaColumbiaSouth Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public HealthUniversity of South CarolinaColumbiaSouth Carolina
| | - Huiying Yang
- Pharmacyclics LLC, an AbbVie CompanySunnyvaleCalifornia
| | - LeAnn B. Norris
- Southern Network on Adverse Reactions (SONAR), South Carolina Center of Economic Excellence for Medication Safety, College of PharmacyUniversity of South CarolinaColumbiaSouth Carolina
| | - Charles L. Bennett
- William Jennings Bryan Dorn Veterans Affairs Medical CenterColumbiaSouth Carolina
- Southern Network on Adverse Reactions (SONAR), South Carolina Center of Economic Excellence for Medication Safety, College of PharmacyUniversity of South CarolinaColumbiaSouth Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public HealthUniversity of South CarolinaColumbiaSouth Carolina
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