1. [Improvement of autoimmune cytopenia with ibrutinib in a chronic lymphocytic leukemia patient complicated by monoclonal immunoglobulin deposition disease].
- Author
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Nakamura M, Yoshioka S, Yamashita D, Hara S, and Ishikawa T
- Subjects
- Adenine analogs & derivatives, Aged, Female, Humans, Piperidines, Rituximab, Antibodies, Monoclonal, Autoimmune Diseases drug therapy, Leukemia, Lymphocytic, Chronic, B-Cell complications, Pyrazoles therapeutic use, Pyrimidines therapeutic use
- Abstract
The clinical course of chronic lymphocytic leukemia (CLL) is often complicated by autoimmune cytopenia (AIC). Here we report a case of a 69-year-old woman with CLL complicated by monoclonal immunoglobulin deposition disease (MIDD) and AIC. The patient was diagnosed with CLL at the age of 63 years and treated with chemotherapy including rituximab and/or fludarabine owing to the development of anemia, multiple lymphadenopathy, and B symptoms at the age of 66 years. Furthermore, pancytopenia and renal failure developed at the age of 68 years. Consequently, the patient was admitted owing to dyspnea. Because of no apparent signs of CLL progression, we concluded that pancytopenia was due to AIC (autoimmune granulocytopenia and thrombocytopenia) and renal anemia. MIDD was diagnosed based on renal histology and detection of IgM and λ chain immunoglobulin deposits on glomeruli and tubules, which were presumed to be derived from CLL cells. The patient was treated with ibrutinib in order to reduce monoclonal protein levels. AIC improved concurrently with IgM reduction 1 month later. Supportive care, involving transfusion and granulocyte colony-stimulating factor, was not required approximately 3 months after initiating ibrutinib treatment. In contrast, MIDD did not improve and maintenance hemodialysis was required. Owing to its antitumor and immunomodulatory effects, ibrutinib may contribute to improve CLL-associated AIC.
- Published
- 2019
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