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Sharman JP, Ghia P, Miranda P, Bajwa N, Rule S, Shaw B, Seymour JF. Analysis of ventricular arrhythmias and sudden death from prospective, randomized clinical trials of acalabrutinib. Br J Haematol 2024; 205:529-533. [PMID: 38634256 DOI: 10.1111/bjh.19469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
This analysis investigated the incidence of sudden deaths (SDs) and non-fatal and fatal ventricular arrhythmias (VAs) in five acalabrutinib clinical trials. In total, 1299 patients received acalabrutinib (exposure, 4568.4 patient-years). Sixteen (1.2%) patients experienced SD or VA (event rate, 0.350/100 patient-years). Non-fatal VAs occurred in 11 (0.8%) patients, nine (0.7%) of whom had premature ventricular contractions only. SD and fatal VAs occurred in five (0.4%) patients (event rate, 0.109/100 patient-years; median time to event: 46.2 months). SDs and VAs with acalabrutinib occurred at low rates, and there are insufficient data to point to an increased risk of SD or VA with acalabrutinib.
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Affiliation(s)
- Jeff P Sharman
- Willamette Valley Cancer Institute and Research Center/US Oncology Research, Eugene, Oregon, USA
| | - Paolo Ghia
- Università Vita-Salute San Raffaele, Milano, Italy
- IRCCS Ospedale San Raffaele, Milano, Italy
| | | | | | | | | | - John F Seymour
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
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Vainer N, Rotbain Curovic V, Niemann CU, Slager SL, Rotbain EC. Understanding the interplay between chronic lymphocytic leukemia and type 2 diabetes. Expert Rev Hematol 2024:1-13. [PMID: 39041465 DOI: 10.1080/17474086.2024.2383417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 07/18/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Comorbidities play an important role in the management of chronic lymphocytic leukemia (CLL) and may influence survival and treatment outcomes. Considering the aging general population and increasing incidence of type 2 diabetes (T2D), a comprehensive understanding of the interplay between CLL and T2D is essential for optimizing care and outcomes. AREAS COVERED We present current knowledge on co-existing CLL and T2D including prevalence, shared etiology and risk factors and how the conditions and treatment hereof may influence the outcome of one another. A literature search was performed using PubMed with the cutoff date on 1 February 2024. EXPERT OPINION The increased mortality observed in persons with CLL who have co-existing T2D is partially ascribed to infections, prompting physicians managing individuals with both conditions to consider closer monitoring during instances of infection and individualized prophylaxis. People with CLL and T2D should be managed for CLL in accordance with the international working group on CLL criteria, and we recommend that physicians exercise particular care not to delay treatment for these individuals. Multidisciplinary approaches with involvement of several specialties may be required for optimal supportive care of co-occurring T2D and CLL.
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Affiliation(s)
- Noomi Vainer
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Hematology Group, Danish Cancer Institute, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Carsten Utoft Niemann
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susan L Slager
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Emelie Curovic Rotbain
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Hematology Group, Danish Cancer Institute, Copenhagen, Denmark
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3
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Song Z, Jiang D, Yu L, Chen Y, Zhou D, Li Y, Wu D, Zhang L, Miao L, Ma J, Zhu J, Jing H, Zhao R, Steering Committee OBOT, Evidence-Based Pharmacy Professional Committee Of Chinese Pharmaceutical Association Cpa TCPATESG, Chinese Pharmaceutical Association Cpa HPPCO, Chinese Pharmacological Society Cps DOTDMO, Clinical Oncology Csco ECOLOCSO, Chinese Society Of Clinical Oncology Csco ECOLO, China Anti-Cancer Association Caca SOICOO, Chinese Medical Association Cma CSOHO, Cross-Straits Medicine Exchange Association Smea HPPCO. Evidence-based expert consensus on clinical management of safety of Bruton's tyrosine kinase inhibitors (2024). Chin J Cancer Res 2024; 36:240-256. [PMID: 38988488 PMCID: PMC11230885 DOI: 10.21147/j.issn.1000-9604.2024.03.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 05/17/2024] [Indexed: 07/12/2024] Open
Abstract
Bruton's tyrosine kinase inhibitors (BTKis) have revolutionized the treatment of B-cell lymphomas. However, safety issues related to the use of BTKis may hinder treatment continuity and further affect clinical efficacy. A comprehensive and systematic expert consensus from a pharmacological perspective is lacking for safety issues associated with BTKi treatment. A multidisciplinary consensus working group was established, comprising 35 members from the fields of hematology, cardiovascular disease, cardio-oncology, clinical pharmacy, and evidence-based medicine. This evidence-based expert consensus was formulated using an evidence-based approach and the Delphi method. The Joanna Briggs Institute Critical Appraisal (JBI) tool and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach were used to rate the quality of evidence and grade the strength of recommendations, respectively. This consensus provides practical recommendations for BTKis medication based on nine aspects within three domains, including the management of common adverse drug events such as bleeding, cardiovascular events, and hematological toxicity, as well as the management of drug-drug interactions and guidance for special populations. This multidisciplinary expert consensus could contribute to promoting a multi-dimensional, comprehensive and standardized management of BTKis.
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Affiliation(s)
- Zaiwei Song
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing 100191, China
| | - Dan Jiang
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing 100191, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Lingling Yu
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing 100191, China
| | - Yixuan Chen
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing 100191, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China
| | - Yue Li
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
| | - Depei Wu
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Lingli Zhang
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu 610041, China
| | - Liyan Miao
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Jun Ma
- Department of Hematology and Oncology, Harbin Institute of Hematology and Oncology, Harbin 150010, China
| | - Jun Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Hongmei Jing
- Department of Hematology, Peking University Third Hospital, Beijing 100191, China
| | - Rongsheng Zhao
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing 100191, China
| | - On Behalf Of The Steering Committee
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing 100191, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu 610041, China
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Hematology and Oncology, Harbin Institute of Hematology and Oncology, Harbin 150010, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
- Department of Hematology, Peking University Third Hospital, Beijing 100191, China
| | - The Consensus Panel And The Evidence Synthesis Group Evidence-Based Pharmacy Professional Committee Of Chinese Pharmaceutical Association Cpa
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing 100191, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu 610041, China
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Hematology and Oncology, Harbin Institute of Hematology and Oncology, Harbin 150010, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
- Department of Hematology, Peking University Third Hospital, Beijing 100191, China
| | - Hospital Pharmacy Professional Committee Of Chinese Pharmaceutical Association Cpa
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing 100191, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu 610041, China
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Hematology and Oncology, Harbin Institute of Hematology and Oncology, Harbin 150010, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
- Department of Hematology, Peking University Third Hospital, Beijing 100191, China
| | - Division Of Therapeutic Drug Monitoring Of Chinese Pharmacological Society Cps
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing 100191, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu 610041, China
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Hematology and Oncology, Harbin Institute of Hematology and Oncology, Harbin 150010, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
- Department of Hematology, Peking University Third Hospital, Beijing 100191, China
| | - Expert Committee On Lymphoma Of Chinese Society Of Clinical Oncology Csco
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing 100191, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu 610041, China
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Hematology and Oncology, Harbin Institute of Hematology and Oncology, Harbin 150010, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
- Department of Hematology, Peking University Third Hospital, Beijing 100191, China
| | - Expert Committee On Leukemia Of Chinese Society Of Clinical Oncology Csco
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing 100191, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu 610041, China
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Hematology and Oncology, Harbin Institute of Hematology and Oncology, Harbin 150010, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
- Department of Hematology, Peking University Third Hospital, Beijing 100191, China
| | - Society Of Integrative Cardio-Oncology Of China Anti-Cancer Association Caca
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing 100191, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu 610041, China
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Hematology and Oncology, Harbin Institute of Hematology and Oncology, Harbin 150010, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
- Department of Hematology, Peking University Third Hospital, Beijing 100191, China
| | - Chinese Society Of Hematology Of Chinese Medical Association Cma
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing 100191, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu 610041, China
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Hematology and Oncology, Harbin Institute of Hematology and Oncology, Harbin 150010, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
- Department of Hematology, Peking University Third Hospital, Beijing 100191, China
| | - Hospital Pharmacy Professional Committee Of Cross-Straits Medicine Exchange Association Smea
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing 100191, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China
- Department of Cardiology, the First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu 610041, China
- Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Hematology and Oncology, Harbin Institute of Hematology and Oncology, Harbin 150010, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
- Department of Hematology, Peking University Third Hospital, Beijing 100191, China
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Patel JN, Singh J, Ghosh N. Bruton's tyrosine kinase inhibitor-related cardiotoxicity: The quest for predictive biomarkers and improved risk stratification. Oncotarget 2024; 15:355-359. [PMID: 38829647 PMCID: PMC11146632 DOI: 10.18632/oncotarget.28589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
Ibrutinib was the first Bruton's tyrosine kinase (BTK) inhibitor approved for the treatment of patients with chronic lymphocytic leukemia (CLL). While producing durable responses and prolonging survival, roughly 20-25% of patients experience dose limiting side effects, mostly consisting of cardiovascular toxicities like severe hypertension and atrial fibrillation. While clinical predictors of BTK inhibitor-related cardiotoxicity have been proposed and may aid in risk stratification, there is no routine risk model used in clinical practice today to identify patients at highest risk. A recent study investigating genetic predictors of ibrutinib-related cardiotoxicity found that single nucleotide polymorphisms in KCNQ1 and GATA4 were significantly associated with cardiotoxic events. If replicated in larger studies, these biomarkers may improve risk stratification in combination with clinical factors. A clinicogenomic risk model may aid in identifying patients at highest risk of developing BTK inhibitor-related cardiotoxicity in which further risk mitigation strategies may be explored.
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Affiliation(s)
- Jai N. Patel
- Department of Cancer Pharmacology and Pharmacogenomics, Atrium Health Levine Cancer Institute, Charlotte, NC 28204, USA
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
| | - Jai Singh
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC 28204, USA
| | - Nilanjan Ghosh
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157, USA
- Department of Hematologic Malignancies and Blood Disorders, Atrium Health Levine Cancer Institute, Charlotte, NC 28204, USA
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Poto R, Marone G, Galli SJ, Varricchi G. Mast cells: a novel therapeutic avenue for cardiovascular diseases? Cardiovasc Res 2024; 120:681-698. [PMID: 38630620 PMCID: PMC11135650 DOI: 10.1093/cvr/cvae066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/28/2023] [Accepted: 01/08/2024] [Indexed: 04/19/2024] Open
Abstract
Mast cells are tissue-resident immune cells strategically located in different compartments of the normal human heart (the myocardium, pericardium, aortic valve, and close to nerves) as well as in atherosclerotic plaques. Cardiac mast cells produce a broad spectrum of vasoactive and proinflammatory mediators, which have potential roles in inflammation, angiogenesis, lymphangiogenesis, tissue remodelling, and fibrosis. Mast cells release preformed mediators (e.g. histamine, tryptase, and chymase) and de novo synthesized mediators (e.g. cysteinyl leukotriene C4 and prostaglandin D2), as well as cytokines and chemokines, which can activate different resident immune cells (e.g. macrophages) and structural cells (e.g. fibroblasts and endothelial cells) in the human heart and aorta. The transcriptional profiles of various mast cell populations highlight their potential heterogeneity and distinct gene and proteome expression. Mast cell plasticity and heterogeneity enable these cells the potential for performing different, even opposite, functions in response to changing tissue contexts. Human cardiac mast cells display significant differences compared with mast cells isolated from other organs. These characteristics make cardiac mast cells intriguing, given their dichotomous potential roles of inducing or protecting against cardiovascular diseases. Identification of cardiac mast cell subpopulations represents a prerequisite for understanding their potential multifaceted roles in health and disease. Several new drugs specifically targeting human mast cell activation are under development or in clinical trials. Mast cells and/or their subpopulations can potentially represent novel therapeutic targets for cardiovascular disorders.
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Affiliation(s)
- Remo Poto
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, Naples 80131, Italy
- World Allergy Organization (WAO), Center of Excellence (CoE), Via S. Pansini 5, Naples 80131, Italy
| | - Gianni Marone
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, Naples 80131, Italy
- World Allergy Organization (WAO), Center of Excellence (CoE), Via S. Pansini 5, Naples 80131, Italy
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Via S. Pansini 5, Naples 80131, Italy
- Institute of Experimental Endocrinology and Oncology ‘G. Salvatore’, National Research Council (CNR), Via S. Pansini 5, Naples 80131, Italy
| | - Stephen J Galli
- Department of Pathology and the Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, 291 Campus Dr, Stanford, CA, USA
- Department of Microbiology and Immunology, Stanford University School of Medicine, 291 Campus Dr, Stanford, CA, USA
| | - Gilda Varricchi
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, Naples 80131, Italy
- World Allergy Organization (WAO), Center of Excellence (CoE), Via S. Pansini 5, Naples 80131, Italy
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Via S. Pansini 5, Naples 80131, Italy
- Institute of Experimental Endocrinology and Oncology ‘G. Salvatore’, National Research Council (CNR), Via S. Pansini 5, Naples 80131, Italy
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6
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Samples L, Voutsinas J, Fakhri B, Khajavian S, Spurgeon S, Stephens D, Skarbnik A, Mato A, Broome C, Gopal A, Smith S, Lynch R, Rainey M, Kim MS, Barrett-Campbell O, Hemond E, Tsang M, Ermann D, Malakhov N, Rao D, Shakib-Azar M, Morrigan B, Chauhan A, Plate T, Gooley T, Ryan K, Lansigan F, Hill B, Pongas G, Parikh SA, Roeker L, Allan JN, Cheng R, Ujjani C, Shadman M. Hypertension treatment for patients receiving ibrutinib: a multicenter retrospective study. Blood Adv 2024; 8:2085-2093. [PMID: 38315043 PMCID: PMC11063398 DOI: 10.1182/bloodadvances.2023011569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/30/2023] [Accepted: 11/19/2023] [Indexed: 02/07/2024] Open
Abstract
ABSTRACT Although Bruton tyrosine kinase inhibitors (BTKis) are generally well tolerated and less toxic than chemotherapy alternatives used to treat lymphoid malignancies, BTKis like ibrutinib have the potential to cause new or worsening hypertension (HTN). Little is known about the optimal treatment of BTKi-associated HTN. Randomly selected patients with lymphoid malignancies on a BTKi and antihypertensive drug(s) and with at least 3 months of follow-up data were sorted into 2 groups: those diagnosed with HTN before BTKi initiation (prior-HTN), and those diagnosed with HTN after BTKi initiation (de novo HTN). Generalized estimating equations assessed associations between time varying mean arterial pressures (MAPs) and individual anti-HTN drug categories. Of 196 patients included in the study, 118 had prior-HTN, and 78 developed de novo HTN. Statistically significant mean MAP reductions were observed in patients with prior-HTN who took β blockers (BBs) with hydrochlorothiazide (HCTZ), (-5.05 mmHg; 95% confidence interval [CI], 10.0 to -0.0596; P = .047), and patients diagnosed with de novo HTN who took either an angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) with HCTZ (-5.47 mmHg; 95% CI, 10.9 to -0.001; P = .05). These regimens also correlated with the greatest percentages of normotensive MAPs. Treatment of HTN in patients taking a BTKi is challenging and may require multiple antihypertensives. Patients with prior-HTN appear to benefit from combination regimens with BBs and HCTZ, whereas patients with de novo HTN appear to benefit from ACEi/ARBs with HCTZ. These results should be confirmed in prospective studies.
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Affiliation(s)
- Laura Samples
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, University of Washington, Seattle, WA
| | - Jenna Voutsinas
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Bita Fakhri
- Division of Hematology and Oncology, University of California, San Francisco, CA
| | - Sirin Khajavian
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Stephen Spurgeon
- Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, OR
| | - Deborah Stephens
- Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT
| | | | - Anthony Mato
- Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Catherine Broome
- Division of Hematology and Oncology, Georgetown University, Washington, DC
| | - Ajay Gopal
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, University of Washington, Seattle, WA
| | - Stephen Smith
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, University of Washington, Seattle, WA
| | - Ryan Lynch
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, University of Washington, Seattle, WA
| | - Magdalena Rainey
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | - Myung Sun Kim
- Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, OR
| | | | - Emily Hemond
- Hematology/Oncology Section, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Mazie Tsang
- Division of Hematology and Oncology, University of California, San Francisco, CA
| | - Daniel Ermann
- Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT
| | - Nikita Malakhov
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Danielle Rao
- Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Beth Morrigan
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Ayushi Chauhan
- Division of Hematology and Oncology, Georgia Cancer Center, Augusta University, Augusta, GA
| | - Thomas Plate
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Ted Gooley
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Frederick Lansigan
- Hematology/Oncology Section, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Brian Hill
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | - Georgios Pongas
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | | | - Lindsey Roeker
- Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John N. Allan
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Richard Cheng
- Division of Cardiology, University of Washington, Seattle, WA
| | - Chaitra Ujjani
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, University of Washington, Seattle, WA
| | - Mazyar Shadman
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, University of Washington, Seattle, WA
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7
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Sontag I, Bergmann L, Adamek HE. Severe Hyperglycemia Due to Protein Kinase Inhibitor Therapy in a Patient With Poorly Controlled Diabetes Mellitus. JCEM CASE REPORTS 2024; 2:luad172. [PMID: 38188906 PMCID: PMC10768878 DOI: 10.1210/jcemcr/luad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Indexed: 01/09/2024]
Abstract
The efficacy and safety of zanubrutinib, a highly selective next-generation Bruton's tyrosine kinase (BTK) inhibitor, in chronic lymphocytic leukemia and lymphoplasmocytoides immunocytoma seems favorable. Adverse events comprise neutropenia, thrombocytopenia, infection, anemia, and atrial fibrillation. This report describes a 75-year-old man suffering from polydipsia, polyuria, and blurred vision for 10 days. He was diagnosed with lymphoplasmocytoides immunocytoma in 2003. After various therapies, he was started on zanubrutinib in October 2022. A diagnosis of diabetes mellitus had never been established before. On arrival in the emergency department, his plasma glucose was 37.2 mmol/L (671 mg/dL) and glycated hemoglobin (HbA1c) was 14.2%. Circulating antibodies showed positivity for glutamic acid decarboxylase (GAD-65), and his C-peptide level was 1.3 nmol/L (normal range, 0.37-1.47 nmol/L), equivalent to 3.9 ng/mL (normal range 1.1-5.0 ng/mL). From the patient's medical history, it became obvious that the metabolic situation had been problematic for many years, and that diabetes could have been taken into account at least in the summer of 2020 when HbA1c was 6.7%. In patients on tyrosine kinase inhibitors, careful assessment of glycemic control (monitoring HbA1c and blood glucose levels periodically even for nondiabetic patients) is recommended to prevent a major diabetic emergency.
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Affiliation(s)
- Isabel Sontag
- Zentrale Notfallambulanz, Klinikum Leverkusen, Academic Hospital of the University of Cologne, Am Gesundheitspark 11, D—51375 Leverkusen, Germany
| | - Laura Bergmann
- Med. Klinik 2, Klinikum Leverkusen, Academic Hospital of the University of Cologne, Am Gesundheitspark 11, D—51375 Leverkusen, Germany
| | - Henning Ernst Adamek
- Med. Klinik 2, Klinikum Leverkusen, Academic Hospital of the University of Cologne, Am Gesundheitspark 11, D—51375 Leverkusen, Germany
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8
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Huntington SF, de Nigris E, Puckett JT, Kamal-Bahl S, Farooqui M, Ryland K, Sarpong EM, Leng S, Yang X, Doshi JA. Real-world analysis of adverse event rates after initiation of ibrutinib among Medicare beneficiaries with chronic lymphocytic leukemia. Cancer Med 2024; 13:e6953. [PMID: 38348963 PMCID: PMC10832339 DOI: 10.1002/cam4.6953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/11/2023] [Accepted: 01/10/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The first-generation BTK inhibitor ibrutinib is a standard-of-care therapy in the treatment of chronic lymphocytic leukemia (CLL) despite potential side effects that often lead to discontinuation. METHODS This study used 2013-2019 claims data to describe the incidence rate of adverse events (AEs) among elderly Medicare beneficiaries newly initiating ibrutinib for CLL. RESULTS The final sample contained 11,870 Medicare beneficiaries with CLL (mean age 77.2) newly initiating ibrutinib, of whom 65.2% discontinued over mean follow-up of 2.3 years. The overall incidence rate of AEs was 62.5 per 1000 patient-months for all discontinuers and 32.9 per 1000 patient-months for non-discontinuers. Discontinuers had a higher incidence rate of AEs per 1000 patient-months compared with non-discontinuers for all AEs examined, including infection (22.8 vs. 14.5), atrial fibrillation (15.1 vs. 7.0), anemia (21.9 vs. 14.5), and arthralgia/myalgia (19.5 vs. 13.6). CONCLUSION In this first real-world study of a national sample of elderly US patients treated with ibrutinib, we found a clear unmet need for improved management of ibrutinib-related AEs and/or new treatments to improve real-world outcomes in patients with CLL.
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Affiliation(s)
- Scott F Huntington
- Department of Internal Medicine, Section of Hematology, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | | | | | | | | | | | - Jalpa A Doshi
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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9
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Andersson ML, Johansson H, Österborg A, Månsson-Broberg A, Hansson L, Palma M. Incidence of cardiovascular and bleeding events and reasons for discontinuation in patients with chronic lymphocytic leukemia treated with ibrutinib-A retrospective analysis on consecutive patients from a well-defined region. Eur J Haematol 2023; 111:748-756. [PMID: 37565648 DOI: 10.1111/ejh.14072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Ibrutinib treatment is associated with cardiovascular side effects, in particular atrial fibrillation (AF) and hypertension, as well as increased risk of bleeding. Here, we aimed at describing the incidence of these events during long-term follow-up in patients with chronic lymphocytic leukemia treated outside clinical trials as well as identifying clinical factors predictive of developing AF. Additionally, other reasons for treatment withdrawal were analyzed. METHODS The study was retrospective, data were collected from medical records. RESULTS A total of 134 patients were identified. Median follow-up was 32 months (range 3-103) and median duration of ibrutinib treatment was 26 months (range 1-103). Of 110 patients with no prior history of AF, 24.5% were diagnosed during treatment. Newly diagnosed or worsening of pre-existing hypertension occurred in 15.7%. Sixty-six % of the patients experienced bleeding events, of which 7.5% grade 3-4. Treatment discontinuation and dose reduction occurred in 68% and 47% of the patients, respectively, mostly due to toxicity. CONCLUSIONS The incidence of AF was high and at a median follow-up of 2.5 years, two-thirds of the patients discontinued treatment mostly due to bleeding and infections. Treatment-related toxicity of any grade should be regarded as a concern of prolonged ibrutinib therapy.
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Affiliation(s)
- Maria L Andersson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Lymphoma Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Österborg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Lymphoma Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Agneta Månsson-Broberg
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Hansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Lymphoma Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Marzia Palma
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Lymphoma Unit, Karolinska University Hospital, Stockholm, Sweden
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10
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Peng X, He L, Liu N, Ruan Y, Zhao X, Guo X, Wang W, Li S, Tang R, Sang C, Jiang C, Yu R, Long D, Du X, Dong J, Ma C. Outcome of cancer patients after atrial fibrillation ablation: Insights from the China-AF registry. Pacing Clin Electrophysiol 2023; 46:1419-1429. [PMID: 37736690 DOI: 10.1111/pace.14830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/30/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Cancer has become significant comorbidity in patients with atrial fibrillation (AF). However, little is known about the efficacy and safety of AF ablation, the first-line rhythm control strategy, in patients with cancer. This study aims to evaluate the incidence and risk of AF recurrence and safety endpoints in patients with cancer compared to the non-cancer group after ablation. METHODS From August 2011 to December 2020, we consecutively enrolled cancer patients in the China-AF cohort. We used propensity score matching (1:3) to select the control group and assessed the risk of AF recurrence and adverse events after ablation in cancer patients using a multivariable Fine and Gray competing risk model. RESULTS A total of 203 patients with cancer were enrolled and 21 of them were active cancer, with a median follow-up of 12.3 months. The cumulative incidence of AF recurrence was comparable between patients with and without cancer (43.8% vs. 51.1%; p = .88). No difference in the risk of AF recurrence, thromboembolism, major bleeding, and mortality was observed after adjusting confounders. Active cancer was not associated with an increased risk of AF recurrence compared to the stable disease (SHR = 1.32; 95% CI 0.72-2.43; p = .46). Cancer was associated with a low risk of cardiovascular hospitalization (SHR, 0.54; 95% CI, 0.36-0.81; p = .01). Subgroup analysis found that hematological malignancy was associated with a high risk of AF recurrence (SHR, 5.68; 95% CI, 3.00-10.8; p < .001). CONCLUSIONS This study suggests that catheter ablation could be feasible for rhythm control of AF patients with concomitant cancer.
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Affiliation(s)
- Xiaodong Peng
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Liu He
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Nian Liu
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Yanfei Ruan
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Xin Zhao
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Xueyuan Guo
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Songnan Li
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Ribo Tang
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Caihua Sang
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Chenxi Jiang
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Ronghui Yu
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Deyong Long
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
- Heart Health Research Center (HHRC), Beijing, China
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | - Jianzeng Dong
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Changsheng Ma
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
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11
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Woo T, Carter M, Follows G, Patten PEM. Case report: Successful treatment of refractory immune thrombocytopenia in chronic lymphocytic leukaemia with venetoclax monotherapy. Front Oncol 2023; 13:1260003. [PMID: 37920161 PMCID: PMC10619646 DOI: 10.3389/fonc.2023.1260003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023] Open
Abstract
In chronic lymphocytic leukaemia (CLL), immune dysregulation is common and can manifest as immune thrombocytopenia (ITP). Corticosteroids are the mainstay for front-line management of CLL-associated ITP. Therapy refractoriness represents a clinical challenge and is an indication to commence CLL-directed treatment, historically with anti-CD20 antibody-based chemoimmunotherapy. There is a small but growing body of evidence supporting the use of Bruton's tyrosine kinase (BTK) inhibitors in this setting, but not the B-cell lymphoma-2 inhibitor, venetoclax. Here, we describe two cases of refractory ITP in patients with CLL who successfully achieved and sustained complete remission with fixed-duration venetoclax monotherapy. Responses were rapid and durable and not explained by the concomitant use of an anti-CD20 antibody. This supports a dual role for single-agent venetoclax in managing active CLL and associated ITP as an alternative to BTK inhibitors and anti-CD20 monoclonals.
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Affiliation(s)
- Timothy Woo
- Department of Haematology, King’s College Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Matthew Carter
- Department of Haematology, Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
| | - George Follows
- Department of Haematology, Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Piers EM. Patten
- Department of Haematology, King’s College Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Medicine, King’s College London, London, United Kingdom
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12
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Mattiello V, Barone A, Giannarelli D, Noto A, Cecchi N, Rampi N, Cassin R, Reda G. Predictors of ibrutinib-associated atrial fibrillation: 5-year follow-up of a prospective study. Hematol Oncol 2023; 41:363-370. [PMID: 36762406 DOI: 10.1002/hon.3126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
Ibrutinib-associated atrial fibrillation (IRAF) emerged among the adverse events of major interests in ibrutinib-treated patients as real-world studies showed a higher incidence compared to clinical trials. We prospectively analyzed predictors of IRAF in 43 single-center consecutive patients affected by chronic lymphocytic leukemia that started therapy with ibrutinib between 2015 and 2017. Key secondary endpoints were to describe the management of IRAF and survival outcomes. During a median follow-up period of 52 months, we registered 45 CV events, with a total of 23 AF events in 13 patients (CI 30.0% (95% CI: 16.5-43.9)). Pre-existent cardiovascular risk factors, in particular hypertension, a previous history of AF and a high Shanafelt risk score emerged as predictors of IRAF. Baseline echocardiographic evaluation of left atrial (LA) dimensions confirmed to predict IRAF occurrence and cut-off values were identified in our cohort: 32 mm for LA diameter and 18 cm2 for LA area. No difference in progression free survival and overall survival emerged in patients experiencing IRAF. Following AF, anticoagulation was started in all eligible patients, and cardioactive therapy was accordingly modified. Echocardiography represents a highly reproducible and widespread tool to be included in the work-up of ibrutinib candidates; the identification of IRAF predictors represents a useful guide to clinical practice.
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Affiliation(s)
| | - Angelica Barone
- Hematology Unit, Fondazione IRCCS Ca' Granda Policlinico, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Diana Giannarelli
- Facility of Epidemiology and Biostatistics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Alessandro Noto
- Hematology Unit, Fondazione IRCCS Ca' Granda Policlinico, Milan, Italy
| | - Nicola Cecchi
- Hematology Unit, Fondazione IRCCS Ca' Granda Policlinico, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Nicolò Rampi
- Hematology Unit, Fondazione IRCCS Ca' Granda Policlinico, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Ramona Cassin
- Hematology Unit, Fondazione IRCCS Ca' Granda Policlinico, Milan, Italy
| | - Gianluigi Reda
- Hematology Unit, Fondazione IRCCS Ca' Granda Policlinico, Milan, Italy
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13
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Molica S, Tam C, Allsup D, Polliack A. Advancements in the Treatment of CLL: The Rise of Zanubrutinib as a Preferred Therapeutic Option. Cancers (Basel) 2023; 15:3737. [PMID: 37509398 PMCID: PMC10377923 DOI: 10.3390/cancers15143737] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Ibrutinib, the first-in-class Bruton's tyrosine kinase inhibitor (BTKi), is a commonly deployed therapeutic option for previously untreated and relapsed/refractory (R/R) patients with chronic lymphocytic leukemia (CLL). The use of ibrutinib is, however, partially limited by off-target side effects. Zanubrutinib (zanu) is a second-generation BTKi with enhanced target selectivity and occupancy of the kinase binding site. The SEQUOIA study showed that zanu significantly prolonged progression-free survival (PFS) when compared to bendamustine-rituximab (BR) in treatment-naive CLL patients. More recently, data from the phase III ALPINE trial, which directly compared zanu with ibrutinib, demonstrated that zanu's advantages include an improved safety profile as well as enhanced clinical efficacy. Based on the results of the SEQUOIA and ALPINE pivotal trials, the Food and Drug Administration (FDA) and European Medicines Agency (EMA) licensed zanu for the treatment of patients with CLL or small lymphocytic lymphoma (SLL) in January 2023. The updated (v2.2023) National Comprehensive Cancer Network (NCCN) guidelines and the most recent German CLL algorithm suggest that zanu may replace first-generation BTKis as a preferred therapeutic option for patients with CLL/SLL due to its increased selectivity for the kinase binding site, improved therapeutic efficacy, and favorable toxicity profile. Some drug class-related characteristics such as drug resistance, low complete remission (CR) rates, and indefinite treatment duration still remain with zanu, and the results from recently completed and ongoing fixed-duration clinical trials, combining zanu with an anti-BCL2 agent, are eagerly awaited with the possible promise of a reduced treatment duration and lower financial burden.
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Affiliation(s)
- Stefano Molica
- Queens Centre for Oncology and Haematology, Castle Hill Hospital, Hull University NHS Trust, Hull HU16 5JQ, UK
| | | | - David Allsup
- Queens Centre for Oncology and Haematology, Castle Hill Hospital, Hull University NHS Trust, Hull HU16 5JQ, UK
- Centre of Biomedicine, Hull York Medical School, University of Hull, Hull HU16 5JQ, UK
| | - Aaron Polliack
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
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14
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Gordon MJ, Jones JE, George B, Peterson C, Burger JA, Jain N, Keating M, Wierda WG, Durand JB, Ferrajoli A. Long-term outcomes in patients with chronic lymphocytic leukemia treated with ibrutinib: Focus on hypertension and cardiovascular toxicity. Cancer 2023; 129:2192-2200. [PMID: 37016930 PMCID: PMC10882584 DOI: 10.1002/cncr.34787] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/13/2023] [Accepted: 02/28/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Continuous ibrutinib administration is needed to maintain efficacy in patients with chronic lymphocytic leukemia (CLL) and, as such, long-term toxicity is a concern. The authors report the 5-year follow-up of patients with CLL who received treatment with ibrutinib with a focus on hypertension and cardiovascular toxicities. METHODS Patient characteristics were assessed, including blood pressure, cardiovascular disease, disease progression, and death. Univariate logistic regression analysis assessed the relation of patient characteristics and the development of new or worsened hypertension. The incidence of hypertensive outcomes was evaluated using competing risk. Survival was estimated using the Kaplan-Meier method. RESULTS Three hundred patients with CLL who were treated with ibrutinib on clinical trials were included. The median patient age at study enrollment was 65 years (range, 29-83 years). Seventy percent of patients were men, and 88% were Caucasian. Sixty-nine percent of patients had hypertension at baseline, and 47% were on antihypertensive medication. Eighty-eight percent had relapsed or refractory CLL. New-onset and worsening hypertension were common, occurring in 68.5% and 38% of patients, respectively. Systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg was observed in 16.9% of patients. Hypertension was reversible after ibrutinib discontinuation. Older age, male sex, tobacco use, and chronic kidney disease were associated with ibrutinib-related hypertension. Baseline hypertension was not associated with major adverse cardiovascular events in ibrutinib-treated patients nor with event-free or overall survival. CONCLUSIONS Hypertension is a common toxicity in patients with CLL who receive ibrutinib but is manageable in most patients. Other than chronic kidney disease, baseline cardiovascular disease did not affect ibrutinib-related hypertension nor was hypertension associated with major adverse cardiovascular events or survival. PLAIN LANGUAGE SUMMARY Ibrutinib is an effective treatment for patients with chronic lymphocytic leukemia. Ibrutinib is a well tolerated therapy, however hypertension can develop or worsen in patients receiving ibrutinib and other cardiovascular events are significant challenges to the use of this drug. This may be particularly true in patients with heart disease. Short-term side effects may worsen heart disease, but the long-term impact is unknown. The long-term results of ibrutinib on heart disease and hypertension are described.
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Affiliation(s)
- Max J Gordon
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jade E Jones
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Binsah George
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Division of Cancer Medicine, Houston, Texas, USA
| | - Christine Peterson
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jan A Burger
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Division of Cancer Medicine, Houston, Texas, USA
| | - Nitin Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Division of Cancer Medicine, Houston, Texas, USA
| | - Michael Keating
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Division of Cancer Medicine, Houston, Texas, USA
| | - William G Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Division of Cancer Medicine, Houston, Texas, USA
| | - Jean-Bernard Durand
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alessandra Ferrajoli
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Division of Cancer Medicine, Houston, Texas, USA
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15
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[Expert consensus on the management of B-cell lymphoma-related cardiovascular diseases with Bruton tyrosine kinase inhibitors (2023)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:359-365. [PMID: 37550184 PMCID: PMC10440626 DOI: 10.3760/cma.j.issn.0253-2727.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Indexed: 08/09/2023]
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16
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Butel-Simoes LE, Haw TJ, Williams T, Sritharan S, Gadre P, Herrmann SM, Herrmann J, Ngo DTM, Sverdlov AL. Established and Emerging Cancer Therapies and Cardiovascular System: Focus on Hypertension-Mechanisms and Mitigation. Hypertension 2023; 80:685-710. [PMID: 36756872 PMCID: PMC10023512 DOI: 10.1161/hypertensionaha.122.17947] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Cardiovascular disease and cancer are 2 of the leading causes of death worldwide. Although improvements in outcomes have been noted for both disease entities, the success of cancer therapies has come at the cost of at times very impactful adverse events such as cardiovascular events. Hypertension has been noted as both, a side effect as well as a risk factor for the cardiotoxicity of cancer therapies. Some of these dynamics are in keeping with the role of hypertension as a cardiovascular risk factor not only for heart failure, but also for the development of coronary and cerebrovascular disease, and kidney disease and its association with a higher morbidity and mortality overall. Other aspects such as the molecular mechanisms underlying the amplification of acute and long-term cardiotoxicity risk of anthracyclines and increase in blood pressure with various cancer therapeutics remain to be elucidated. In this review, we cover the latest clinical data regarding the risk of hypertension across a spectrum of novel anticancer therapies as well as the underlying known or postulated pathophysiological mechanisms. Furthermore, we review the acute and long-term implications for the amplification of the development of cardiotoxicity with drugs not commonly associated with hypertension such as anthracyclines. An outline of management strategies, including pharmacological and lifestyle interventions as well as models of care aimed to facilitate early detection and more timely management of hypertension in patients with cancer and survivors concludes this review, which overall aims to improve both cardiovascular and cancer-specific outcomes.
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Affiliation(s)
- Lloyd E Butel-Simoes
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
- College of Health and Medicine, University of Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Tatt Jhong Haw
- College of Health and Medicine, University of Newcastle, NSW Australia
- Newcastle Centre of Excellence in Cardio-Oncology, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Trent Williams
- College of Health and Medicine, University of Newcastle, NSW Australia
- Newcastle Centre of Excellence in Cardio-Oncology, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Shanathan Sritharan
- Department of Medicine, Hunter New England Local Health District, NSW, Australia
| | - Payal Gadre
- Department of Medicine, Hunter New England Local Health District, NSW, Australia
| | - Sandra M Herrmann
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55902, USA
| | - Doan TM Ngo
- College of Health and Medicine, University of Newcastle, NSW Australia
- Newcastle Centre of Excellence in Cardio-Oncology, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Aaron L Sverdlov
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
- College of Health and Medicine, University of Newcastle, NSW Australia
- Newcastle Centre of Excellence in Cardio-Oncology, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
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Human Lung Mast Cells: Therapeutic Implications in Asthma. Int J Mol Sci 2022; 23:ijms232214466. [PMID: 36430941 PMCID: PMC9693207 DOI: 10.3390/ijms232214466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Mast cells are strategically located in different compartments of the lung in asthmatic patients. These cells are widely recognized as central effectors and immunomodulators in different asthma phenotypes. Mast cell mediators activate a wide spectrum of cells of the innate and adaptive immune system during airway inflammation. Moreover, these cells modulate the activities of several structural cells (i.e., fibroblasts, airway smooth muscle cells, bronchial epithelial and goblet cells, and endothelial cells) in the human lung. These findings indicate that lung mast cells and their mediators significantly contribute to the immune induction of airway remodeling in severe asthma. Therapies targeting mast cell mediators and/or their receptors, including monoclonal antibodies targeting IgE, IL-4/IL-13, IL-5/IL-5Rα, IL-4Rα, TSLP, and IL-33, have been found safe and effective in the treatment of different phenotypes of asthma. Moreover, agonists of inhibitory receptors expressed by human mast cells (Siglec-8, Siglec-6) are under investigation for asthma treatment. Increasing evidence suggests that different approaches to depleting mast cells show promising results in severe asthma treatment. Novel treatments targeting mast cells can presumably change the course of the disease and induce drug-free remission in bronchial asthma. Here, we provide an overview of current and promising treatments for asthma that directly or indirectly target lung mast cells.
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