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Song Y, Wu SJ, Shen Z, Zhao D, Chan TSY, Huang H, Qiu L, Li J, Tan TD, Zhu J, Song Y, Huang WH, Zhao W, Liu HSY, Xu W, Chen N, Ma J, Chang CS, Tse EWC. Chinese expert consensus on Bruton tyrosine kinase inhibitors in the treatment of B-cell malignancies. Exp Hematol Oncol 2023; 12:92. [PMID: 37845755 PMCID: PMC10578030 DOI: 10.1186/s40164-023-00448-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/15/2023] [Indexed: 10/18/2023] Open
Abstract
Targeted therapy with Bruton tyrosine kinase (BTK) inhibitors have revolutionized the treatment of patients with various B-cell malignancies. BTK inhibitors such as ibrutinib, zanubrutinib, orelabrutinib, and acalabrutinib have shown good clinical efficacy and better safety profiles than those of traditional chemotherapy and chemoimmunotherapy regimens. Multiple studies on new BTK inhibitors are ongoing, which may provide more therapeutic options for the treatment of B-cell malignancies. Considering the unmet need of evidence on BTK inhibitors in all clinical settings and to standardize the use of BTK inhibitors available in mainland China, Taiwan, Hong Kong, and Macau regions, this consensus has been formulated for the treatment of various B-cell malignancies based on the clinical practice and available evidences on the use of BTK inhibitors. The recommendations of this consensus will provide guidance to physicians and clinical researchers on the effective treatment of B-cell malignancies with BTK inhibitors.
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Affiliation(s)
- Yuqin Song
- Peking University Cancer Hospital and Institute, Beijing, China
| | - Shang-Ju Wu
- Hematology Division, Department of Internal Medicine, National Taiwan University Hospital, Taiwan, China
| | - Zhixiang Shen
- Shanghai Jiaotong University Affiliated Ruijin Hospital, Shanghai, China
| | - Donglu Zhao
- Harbin Hematology and Oncology Institute, Heilongjiang, 150007, China
| | | | | | - Lugui Qiu
- Institute of Hematology and Blood Diseases Hospital, Tianjing, China
| | - Jianyong Li
- Jiangsu Provincial People's Hospital, Jiangsu, China
| | - Tran-der Tan
- Department of Hematology and Medical Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taiwan, China
| | - Jun Zhu
- Peking University Cancer Hospital and Institute, Beijing, China
| | - Yongping Song
- The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Wei-Han Huang
- Department of Clinical Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan, China
| | - Weili Zhao
- Shanghai Jiaotong University Affiliated Ruijin Hospital, Shanghai, China
| | | | - Wei Xu
- Jiangsu Provincial People's Hospital, Jiangsu, China
| | - Naizhi Chen
- Macau Society of Hematology and Oncology, Macau, China
| | - Jun Ma
- Harbin Hematology and Oncology Institute, Heilongjiang, 150007, China.
| | - Cheng-Shyong Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Taiwan, China.
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taiwan, China.
| | - Eric Wai Choi Tse
- Department of Medicine, School of Clinical Medicine, University of Hong Kong, Hong Kong, China.
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Lam LK, Chan TSY, Hwang YY, Mak LY, Seto WK, Kwong YL, Yuen MF. Hepatitis B virus reactivation in seronegative occult hepatitis B patient receiving ibrutinib therapy. Virol J 2023; 20:168. [PMID: 37528444 PMCID: PMC10394758 DOI: 10.1186/s12985-023-02140-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Ibrutinib is a Bruton's tyrosine kinase (BTK) inhibitor approved for the treatment for several mature B-cell malignancies. Reactivation of hepatitis B virus (HBV) is a well-described complication in patients with chronic HBV infection or prior HBV exposure undergoing cytotoxic or immunosuppressive chemotherapy for hematologic malignancies. This phenomenon has been frequently reported with rituximab. However, published data on the risk of HBV reactivation induced by ibrutinib are scarce. Cases of HBV reactivation in hematologic patients receiving ibrutinib therapy have recently been described, but limited only to overt hepatitis B patients or seropositive occult hepatitis B patients. CASE PRESENTATION We report the first case of HBV reactivation during ibrutinib treatment in an asymptomatic 82-year-old woman with seronegative occult hepatitis B patient (i.e., negative for HBsAg, anti-HBc and anti-HBs). Four months after ibrutinib treatment, her liver function test (LFT) was deranged, with seroconversion to HBsAg positivity. Serum hepatitis B virus DNA was quantified to be 1.92 × 108 IU/ml. Antiviral treatment was initiated, and viral load was gradually suppressed with improvement in LFT. CONCLUSIONS Our case illustrated that in populations with a high incidence of HBV exposure, systematic screening for HBV exposure is essential prior to ibrutinib treatment, followed by serial monitoring of serologic and molecular markers of hepatitis B. There is a need for an international consensus to support the recommendation of antiviral prophylaxis against HBV reactivation in patients using ibrutinib.
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Affiliation(s)
- Lok-Ka Lam
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Pokfulam, Hongkong
| | - Thomas Sau Yan Chan
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Pokfulam, Hongkong
| | - Yu-Yan Hwang
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Pokfulam, Hongkong
| | - Lung-Yi Mak
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Pokfulam, Hongkong
- State Key Laboratory of Liver Research, The University of Hong Kong, Pokfulam, Hongkong
| | - Wai-Kay Seto
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Pokfulam, Hongkong
- State Key Laboratory of Liver Research, The University of Hong Kong, Pokfulam, Hongkong
| | - Yok-Lam Kwong
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Pokfulam, Hongkong
| | - Man-Fung Yuen
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Pokfulam, Hongkong.
- State Key Laboratory of Liver Research, The University of Hong Kong, Pokfulam, Hongkong.
- Queen Mary Hospital, Professorial Block, 102, Pokfulam Road, Hong Kong.
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Chan KY, Chan TSY, Gill H, Chan TCW, Li CW, Au HY, Wong CY, Tsang KW, Lo RSK, Cheng BHW, Hui CH, Mok LWS, Kwok CSL, Chan ML, Sham MK. Supportive care and symptom management in patients with advanced hematological malignancies: a literature review. Ann Palliat Med 2022; 11:3273-3291. [DOI: 10.21037/apm-22-691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022]
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Chan KY, Gill HSH, Chan TSY, Li CW, Tsang KW, Au HY, Wong CY, Hui CH, Mok LWS. Impact of integrated palliative care in acute and aggressive medical care for patients with advanced haematological malignancies: a retrospective matched case-control study. Lancet Oncol 2022. [DOI: 10.1016/s1470-2045(22)00409-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chan TT, Leung WCY, Chan CK, Lo HKT, Tso WWY, Tsui SH, Chan TSY, Chang RSK. Clinical experience in diagnosis and management of acquired methaemoglobinaemia: a case report and retrospective review. Hong Kong Med J 2021; 27:366-369. [PMID: 34706989 DOI: 10.12809/hkmj209028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- T T Chan
- Accident and Emergency Department, Queen Mary Hospital, Hong Kong
| | - W C Y Leung
- Department of Medicine, Queen Mary Hospital, Hong Kong
| | - C K Chan
- Clinical Toxicology Department, United Christian Hospital, Hong Kong
| | - H K T Lo
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong
| | - W W Y Tso
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - S H Tsui
- Accident and Emergency Department, Queen Mary Hospital, Hong Kong
| | - T S Y Chan
- Department of Medicine, Queen Mary Hospital, Hong Kong
| | - R S K Chang
- Department of Medicine, Queen Mary Hospital, Hong Kong
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Chan KY, Gill H, Li CW, Chan TSY, Au HY, Wong CY, Tsang KW, Lo RSK, Cheng BHW. Impact of enhanced haematology palliative care services in patients with myelodysplastic syndrome and acute myeloid leukaemia: study protocol for a randomized controlled trial. Ann Palliat Med 2021; 10:10013-10021. [PMID: 34628925 DOI: 10.21037/apm-20-1633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/13/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) suffer from a significant symptom burden and psychological, spiritual, social needs comparable to patients with solid metastatic malignancy. Referral to palliative care services for these haematological patients remains limited or often confined to the last days of life. We pioneered a palliative care (PC) program integrated with standard haematological care. The purpose of this trial will study the interventions by the PC team and preliminary results in the clinical outcomes. METHODS This project is a non-blinded, randomized, controlled trial. In this study, we examine the clinical outcomes of the integrated PC program for MDS/AML patients when the 2nd lines disease treatment failed and in the presence of prognostic indicators. In group 1, patients will receive standard haematological care associated with PC (i.e., intervention group). In contrast, in group 2, patients will receive standard haematological care only (i.e., control group) with PC service only on a request basis. Patients who join the program would have to complete a standardized questionnaire to assess their quality of life and their psychological and physical symptoms. RESULTS This is to exam the impact of the early integrated palliative care with enhanced psychosocial interventions to both advanced MDS/AML patients and their primary family members in Hong Kong. DISCUSSION This protocol will not display any result. If future results demonstrate that the enhanced PC interventions are effective, they will provide a quality treatment plan for patients with MDS/AML. TRIAL REGISTRATION The Hong Kong University/Hospital Authority Hong Kong West Institutional Review Board (HKU/HA HKW IRB). The registration number is UW 19-824.
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Affiliation(s)
- Kwok Ying Chan
- Palliative Medical Unit, Grantham Hospital, Hong Kong, China
| | - Harinder Gill
- Division of Haematology, Department of Medicine, Queen Mary Hospital, Hong Kong, China; Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Cho Wing Li
- Palliative Medical Unit, Grantham Hospital, Hong Kong, China
| | - Thomas Sau Yan Chan
- Division of Haematology, Department of Medicine, Queen Mary Hospital, Hong Kong, China
| | - Ho Yan Au
- Palliative Medical Unit, Grantham Hospital, Hong Kong, China
| | - Chi Yan Wong
- Palliative Medical Unit, Grantham Hospital, Hong Kong, China
| | - Kwok Wai Tsang
- Palliative Medical Unit, Grantham Hospital, Hong Kong, China
| | | | - Benjamin Hon Wai Cheng
- Medical Palliative Medicine Team, Department of Medicine and Geriatric, Tuen Mun Hospital, Hong Kong, China
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Chan KY, Gill H, Chan TSY, Li CW, Tsang KW, Au HY, Wong CY, Hui CH. Early integrated palliative care for haematology cancer patients-the impact on symptom burden in Hong Kong. Ann Palliat Med 2021; 10:6316-6324. [PMID: 34237956 DOI: 10.21037/apm-21-276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/13/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Evidence showed that early palliative care could have many benefits in clinical outcomes for patients living with advanced medical illnesses. In fact, most of these studies have not involved patients with advanced haematologic cancer (HC), which are known to be associated with significant physical and psychological symptoms. In Hong Kong, an Early Integrated Palliative Care (EIPC) collaboration involving both Heamatology unit of Queen Mary Hospital (QMH) and the Palliative Medical Unit of Grantham Hospital (GH) has been started since early 2018 as a better way to improve the service gap. The HC patients failed 2 or more lines of cancer treatment are identified during the joint round and hematology clinic. Some of these patients will be referred to our PC services. Our joint PC clinic has multidisciplinary input from palliative care physicians, hematologists, and clinical psychologists. The clinic program is well coordinated and structured. The HC patients are initially seen by the parent team for disease treatment and then by GH PC team for symptom control and psychosocial care. METHODS This was a retrospective study with a review of the clinical charts and electronic healthcare records of all patients who attended the Hematology PC clinic from June 2018 to September 2020. For the inclusion criteria, patients were found eligible if they had prospectively completed Edmonton Symptom Assessment Scale (ESAS) assessments for at least the initial and follow-up visits within a range of ≥7 days and ≤60 days of the first visit. RESULTS Thirty-eight patients ultimately agreed to the referral. The mean age was 70.5 (12.5) years old. Twenty-five patients (66%) had myelodysplastic syndrome (MDS); 10 (26%) had acute myeloid leukemia (AML). Around 50-60% of patients reported significant symptoms of fatigue, anxiety, drowsiness, and anorexia; 42% of patients had significantly depressed moods while 37% had pain. There were significant symptom improvements for pain, depression, and anxiety after follow-up visits. CONCLUSIONS The study showed that our EIPC program resulted in a significant reduction in some of the important symptom item scores, including pain, anorexia, anxiety, and depression, after the follow-up visits.
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Affiliation(s)
- Kwok Ying Chan
- Palliative Medical Unit, Grantham Hospital, Hong Kong, China
| | - Harinder Gill
- Division of Haematology, Department of medicine, Queen Mary Hospital, Hong Kong, China; Department of medicine, The University of Hong Kong, Hong Kong, China
| | - Thomas Sau Yan Chan
- Division of Haematology, Department of medicine, Queen Mary Hospital, Hong Kong, China
| | - Cho Wing Li
- Palliative Medical Unit, Grantham Hospital, Hong Kong, China
| | - Kwok Wai Tsang
- Palliative Medical Unit, Grantham Hospital, Hong Kong, China
| | - Ho Yan Au
- Palliative Medical Unit, Grantham Hospital, Hong Kong, China
| | - Chi Yan Wong
- Palliative Medical Unit, Grantham Hospital, Hong Kong, China
| | - Chun Him Hui
- Palliative Medical Unit, Grantham Hospital, Hong Kong, China
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Tse E, Chan TSY, Koh LP, Chng WJ, Kim WS, Tang T, Lim ST, Lie AKW, Kwong YL. Allogeneic haematopoietic SCT for natural killer/T-cell lymphoma: a multicentre analysis from the Asia Lymphoma Study Group. Bone Marrow Transplant 2014; 49:902-6. [DOI: 10.1038/bmt.2014.65] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 12/18/2013] [Accepted: 12/19/2013] [Indexed: 02/07/2023]
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