Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Egger, M.
Invasive fungal infections in patients with hematological malignancies receiving ibrutinib therapy (INFINITY)
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2021. pp. 42
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- Autor*innen der Med Uni Graz:
- Egger Matthias Florian
- Betreuer*innen:
- Prattes Jürgen
- Zurl Christoph Johann
- Altmetrics:
- Abstract:
- Background Since the broad implementation of ibrutinib, an irreversible Bruton’s tyrosine kinase (BTK) inhibitor approved in 2013 for the treatment of non-Hodgkin’s lymphoma (NHL) including chronic lymphocytic leukemia (CLL), an increasing number of case series and retrospective studies reporting on infectious complications like invasive fungal infections (IFIs) associated with ibrutinib administration have emerged. Epidemiologic data, as well as the exact mechanisms and extent of ibrutinib enhancing susceptibility to IFIs, is fragmentary. We tried to shed a little more light on the role of ibrutinib acting as an independent risk factor for IFIs, and the dynamics of infection events in patients receiving it. Methods We conducted a two-centered retrospective study by analyzing electronical medical records of patients who received ibrutinib between October 2020 and August 2021. Presence of IFI was identified by examination of laboratory, radiological and microbiology findings according to EORTC/MSG diagnostic criteria. Prevalence for IFIs in investigated patients was calculated. Results Ninety-seven patients with NHL and ibrutinib therapy were retrospectively analyzed. CLL was the most frequent underlying hematological malignancy in 76 cases. Fourty-eight percent of patients received previous treatment lines for their underlying diseases. One patient developed a probable IFI according to 2019 EORTC/MSG diagnostic criteria implying a prevalence of 0.97%. Invasive pulmonary aspergillosis was the underlying type of IFI, with Aspergillus fumigatus being the causative pathogen. The patient with IFI had concomitant established risk factors (e.g. neutropenia, corticosteroid usage) and received one previous treatment line. The patient died approximately 2.5 years after the IPA episode due to a coronavirus-19 associated ARDS episode. Conclusion Incidence of IFIs was low in this study, with only a single case diagnosed with invasive aspergillosis. The case of invasive fungal infection was diagnosed in a patient who had concomitant risk factors for IFIs, besides ibrutinib therapy. Thus, standardized approaches for the appropriate risk stratification of IFI occurrence, including baseline risk factors, stage of the underlying diseases, etc., in patients receiving ibrutinib or other small molecule kinase inhibitors (SMKI) are recommended.