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Idelalisib-associated Colitis
- Source :
- American Journal of Surgical Pathology. 39:1661-1667
- Publication Year :
- 2015
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2015.
-
Abstract
- Idelalisib is an inhibitor of the PI3Kδ isoform approved for treatment of patients with relapsed chronic lymphocytic leukemia and indolent non-Hodgkin lymphoma. Many patients develop gastrointestinal symptoms during idelalisib therapy; however, the pathologic effects of this drug have not been characterized. We identified 50 patients who received at least 3 months of idelalisib therapy. Clinical findings and symptoms were noted for each patient, and endoscopic findings were recorded for those who underwent colonoscopic examination. Hematoxylin and eosin-stained sections from colonic biopsy samples were evaluated for histologic patterns of injury. Twenty-three (46%) patients experienced diarrhea during treatment with idelalisib, including 8 with severe symptoms (≥7 stools/d above baseline and/or requiring hospitalization). Fourteen patients underwent colonoscopic examination with mucosal biopsy. Twelve (86%) of these had colitis characterized by intraepithelial lymphocytosis, crypt cell apoptosis, and neutrophilic infiltration of crypt epithelium. Eleven patients had symptoms severe enough to warrant drug withdrawal, including 9 who were also treated with corticosteroids. Idelalisib commonly causes diarrheal symptoms in patients undergoing therapy for B-cell neoplasia, which may be severe in nearly 20% of patients. Characteristic histologic features include the combination of intraepithelial lymphocytosis and crypt cell apoptosis, often accompanied by neutrophils. Discontinuation of the drug results in symptomatic improvement and resolution of histologic changes.
- Subjects :
- Male
Oncology
Lymphocytosis
Biopsy
medicine.medical_treatment
Apoptosis
Severity of Illness Index
Gastroenterology
Intestinal mucosa
Adrenal Cortex Hormones
Recurrence
Medicine
Molecular Targeted Therapy
Intestinal Mucosa
Aged, 80 and over
medicine.diagnostic_test
Lymphoma, Non-Hodgkin
Colonoscopy
Middle Aged
Colitis
Immunohistochemistry
Treatment Outcome
Female
Anatomy
medicine.symptom
Idelalisib
Diarrhea
medicine.medical_specialty
Class I Phosphatidylinositol 3-Kinases
Colon
Antineoplastic Agents
Pathology and Forensic Medicine
Drug withdrawal
Internal medicine
Humans
Protein Kinase Inhibitors
Aged
Quinazolinones
Retrospective Studies
Chemotherapy
business.industry
medicine.disease
Leukemia, Lymphocytic, Chronic, B-Cell
Lymphoma
Purines
Surgery
business
Biomarkers
Subjects
Details
- ISSN :
- 01475185
- Volume :
- 39
- Database :
- OpenAIRE
- Journal :
- American Journal of Surgical Pathology
- Accession number :
- edsair.doi.dedup.....dd8a90ebfdcda6b5e21e0e8b22b3e1f9