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Updated: Mar 15, 2026
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Published on: November 26, 2018
Atrial fibrillation in CLL patients treated with ibrutinib. An international retrospective study
Philip A Thompson1, Vincent Lévy2, Constantine S Tam3
1Department of Leukemia, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA.
Insights
Ibrutinib treatment for chronic lymphocytic leukemia (CLL) can cause atrial fibrillation (AF), leading to serious cardiac events and bleeding. Management strategies and clinical guidelines for AF in CLL patients on ibrutinib are urgently needed.
Area of Science:
- Oncology
- Cardiology
- Hematology
Background:
- Ibrutinib is a targeted therapy for chronic lymphocytic leukemia (CLL).
- Atrial fibrillation (AF) is a known side effect of ibrutinib, affecting 5-9% of patients.
- The clinical impact and management of AF in CLL patients receiving ibrutinib are not well-defined.
Purpose of the Study:
- To investigate the clinical consequences of atrial fibrillation (AF) in patients with chronic lymphocytic leukemia (CLL) treated with ibrutinib.
- To evaluate the persistence and management challenges of AF in this patient population.
- To highlight the need for clinical practice guidelines.
Main Methods:
- Retrospective study of 56 chronic lymphocytic leukemia (CLL) patients who developed atrial fibrillation (AF) while on ibrutinib therapy.
- Analysis of time to AF onset, AF persistence, clinical consequences, and treatment outcomes.
Main Results:
- Atrial fibrillation (AF) onset occurred at a median of 3.8 months after initiating ibrutinib.
- AF persisted in 62% of patients despite treatment.
- Severe clinical consequences included cardiac failure (one fatal) and stroke.
- Fourteen percent of patients experienced severe bleeding events.
- Ibrutinib was permanently discontinued in 46% of cases due to AF or its complications.
Conclusions:
- Atrial fibrillation (AF) is a significant complication of ibrutinib therapy in chronic lymphocytic leukemia (CLL) patients, with substantial clinical consequences.
- Persistent AF and associated risks like cardiac failure and bleeding necessitate careful monitoring and management.
- Current data are insufficient to guide optimal management, underscoring the urgent need for clinical practice guidelines.
Abstract:
Atrial fibrillation (AF) occurs in 5-9% of patients treated with ibrutinib for chronic lymphocytic leukaemia (CLL); the clinical consequences and optimal management are unclear. We retrospectively studied 56 CLL patients who received ibrutinib and developed AF. Median time to onset was 3·8 months. AF was persistent in 35/56 (62%) cases despite treatment. Clinical consequences included: three episodes of severe cardiac failure (one fatal) and one stroke; eight non-thrombocytopenic patients (14%) experienced severe bleeding adverse events. Altogether, ibrutinib was permanently discontinued in 26/56 cases (46%). Data to guide optimal management are lacking and clinical practice guidelines are urgently needed.
