Multiple skin tumors in a patient treated with orelabrutinib for mantle-cell lymphoma: Case report

Mantle-cell lymphoma (MCL) is an aggressive B-cell non-Hodgkin lymphoma. Bruton tyrosine kinase inhibitors (BTKi) significantly improve the prognosis of MCL, but their long-term use may induce immunosuppression-related complications, including secondary malignancies. First-generation BTKi such as Ibrutinib have been reported to be associated with the development of skin cancer.

A 77-year-old male patient with MCL treated with the next-generation highly selective BTKi Orelabrutinib (150mg/ day) developed multiple different types of skin tumors.

Skin pathological examination confirmed basal cell carcinoma of the nose, squamous cell carcinoma, actinic keratosis and seborrheic keratosis of the chest skin.

Orelabrutinib was suspended and switched to chemotherapy. The nasal and chest skin tumors were resected, the nasal wound was repaired with adjacent flap, and the chest wound was repaired with skin grafting.

The wound recovered well after the operation, but the patient died of multiple organ failure due to pulmonary infection 5 months later.

Orelabrutinib may be associated with multiple skin tumors, and the mechanism may be through complex immune dysregulation. It is recommended that patients receiving long-term BTKi therapy undergo regular dermatological examinations.