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2017 ; 129
(10
): 1270-1274
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How I manage ibrutinib-refractory chronic lymphocytic leukemia
#MMPMID28096090
Woyach JA
Blood
2017[Mar]; 129
(10
): 1270-1274
PMID28096090
show ga
The introduction of the Bruton tyrosine kinase (BTK) inhibitor ibrutinib has
dramatically changed the management of chronic lymphocytic leukemia (CLL).
Although responses have been durable in the majority of patients, relapses do
occur, especially in the high-risk patient population. Most relapses occur as the
result of acquired mutations in BTK and PLCG2, which may facilitate success with
alternative targeted therapies. As outcomes after ibrutinib relapse have been
reported to be poor, specific strategies are needed for this patient population.
Here, I discuss the diagnosis and management of ibrutinib-refractory CLL. The
focus will be on common clinical scenarios that can be mistaken for relapse and
how to accurately determine which patients are relapsing. Because there is no
established standard of care, I discuss currently available options for standard
therapy and existing clinical data. I also discuss new agents with the potential
to be effective in patients refractory to ibrutinib. Finally, I discuss
strategies for long-term disease control in this patient population.
free
free
free
