Preexisting And Treatment-Emergent Autoimmune Cytopenias In Patients With CLL Treated With Targeted Drugs

Preexisting And Treatment-Emergent Autoimmune Cytopenias In Patients With CLL Treated With Targeted Drugs

Autoimmune cytopenias, whether they be autoimmune hemolytic anemia or immune thrombocytopenic purpura, are well-documented in CLL patients.  The effects of targeted therapies in CLL, and their effects of cytopenias, are being currently investigated.  Published in the Journal Blood, on June 24, 2021, investigators report on the effects of targeted therapies including ibrutinib, idelalisib, and venetoclax on autoimmune cytopenias in CLL patients.  The characteristics and outcomes of pre-existing autoimmune cytopenias as well as the incidence, quality and management of treatment emergent autoimmune cytopenias during therapy with targeted drugs were analyzed for the study.  

572 patients treated with ibrutinib, 9% in combination with an anti-CD20 monoclonal antibody, 143 patients with idelalisib–rituximab, and 100 patients with venetoclax, 12% in combination with an anti-CD20 monoclonal antibody were evaluated.  13% of the 815 patients had pre-existing autoimmune cytopenias.  80% of patients whose autoimmune cytopenias had not resolved when treated with targeted therapy started in for experiencing an improvement or even resolution after some time elapsed on therapy.  Treatment emergent autoimmune cytopenias were seen in 1% of patients with ibrutinib, 0.9% during idelalisib and 7% during venetoclax therapy.  

The authors stated that the vast majority of these cases developed in patients with unfavorable biological features, such as unmutated immunoglobulin heavy chain or deletions in the 17p or TP53 mutations.  Even with autoimmune cytopenias, 83% of patients were able to proceed with therapy without interruption.  Some patients were allowed to have additional immunosuppressive therapy.  The authors concluded “overall, treatment with ibrutinib, idelalisib, or venetoclax appears to have a beneficial impact on CLL associated autoimmune cytopenias, inducing an improvement or even resolution of pre-existing autoimmune cytopenias in most cases and eliciting treatment emergent autoimmune cytopenias in the next interval portion of patients.”