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Managing Ibrutinib-Intolerant Patients With B-Cell Malignancies

Javier Muñoz1, Shayna Sarosiek2, Jorge J Castillo2

  • 1Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA.

The Oncologist
|February 1, 2023
PubMed

Ibrutinib is a first-generation inhibitor of Bruton tyrosine kinase (BTK) that is currently approved to treat patients with B-cell malignancies, including Waldenström macroglobulinemia (WM), relapsed/refractory (R/R) mantle cell lymphoma (MCL), R/R marginal zone lymphoma (MZL), and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Off-target adverse effects, such as atrial fibrillation, hypertension, and bleeding, have been observed and may limit a patient's tolerance for treatment. Currently, there is no well-established treatment regimen for patients who cannot tolerate ibrutinib. Approaches to address such patients include managing ibrutinib side effects with supportive care or dose reductions, switching to an alternative covalent BTK inhibitor, or abandoning covalent BTK inhibitors for alternative forms of treatment. Here we review the literature and provide guidance on treating ibrutinib-intolerant patients with B-cell malignancies.

Keywords:
Bruton’s tyrosine kinaseWaldenström macroglobulinemiachronic lymphocytic leukemiamantle cell lymphomamarginal zone lymphoma

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