Authored by Ann Liu, PhD
Medically Reviewed by Brian Koffman, MDCM (retired), MSEd
The Bottom Line:
Patients with CLL who have to discontinue a BTK inhibitor due to adverse side effects can still experience prolonged remissions without therapy. For patients with well-controlled disease, a period of close monitoring may be appropriate rather than immediately starting another therapy.
Who Performed the Research and Where Was it Presented:
Dr. Jennifer Woyach from the Ohio State University and colleagues presented the results at the American Society for Hematology (ASH) Annual Meeting 2024.
Background:
Bruton tyrosine kinase inhibitors (BTKi) have significantly improved outcomes for patients with chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL). However, some patients have to discontinue treatment because they are not able to tolerate the side effects. Well-known side effects of BTKi that can lead to discontinuation of therapy include gastrointestinal disturbances, joint pain, bleeding, high blood pressure, and abnormal heart rhythms. With this study, researchers were trying to see if patients with CLL / SLL who discontinue BTKi due to adverse side effects need to start on another therapy immediately or if they can take a break.
Methods and Participants:
This retrospective study used medical chart data from patients treated at the Ohio State University. It included patients with CLL who started treatment with a BTKi (ibrutinib or acalabrutinib) between 2010 and 2020 and discontinued therapy due to adverse side effects.
Results:
- During the study timeframe, 709 patients with CLL started a BTKi; 559 received ibrutinib, and 150 received acalabrutinib.
- Of those patients, 145 (20%) were discontinued due to adverse side effects (22% of ibrutinib-treated patients and 15% of acalabrutinib-treated patients).
- The median duration of BTKi treatment was 27 months, and the median duration of follow-up after BTKi discontinuation was 20 months.
- Median progression-free survival after BTKi discontinuation was 21 months.
- The median time-to-next-treatment after BTKi discontinuation was 24 months.
- The median overall survival after BTKi discontinuation was 78 months.
- Having had fewer previous lines of therapy and being on BTKi for a longer duration were associated with longer progression-free survival.
Conclusions:
Patients with CLL who have to discontinue BTKi therapy due to adverse side effects likely do not need to immediately start another treatment if they are in remission. Data from this study shows that it may be years before the following line of treatment is required for some patients.
Links and Resources:
Watch the interview on the abstract here:
You can read the ASH abstract here: Outcomes of Patients with Chronic Lymphocytic Leukemia Discontinuing Bruton Tyrosine Kinase Inhibitors Due to Adverse Effects.
