International Journal of Hematology and Oncology
2023, Vol 33, Num 4 Page(s): 191-197
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Clinical Outcomes of CNS Lymphoma Treated with Ibrutinib-Based Therapy: A Real-Life Multicenter Experience on Off-Label Use of Ibrutinib
Utku ILTAR1, Ozan SALIM1, Unal ATAS2, Ece VURAL1, Fadime Nurcan ALHAN1, Orhan Kemal YUCEL1, Hasan SOZEL1, Serkan GUVEN3, Ayfer GEDUK4, Burak DEVECI5, Istemi SERIN6, Tugrul ELVERDI7, Fatma Keklik KARADAG8, Volkan KARAKUS2, Umit Yavuz MALKAN9, Anil TOMBAK10, Turgay ULAS11, Pinar TARKUN4, Ahmet Emre ESKAZAN7, Inci ALACACIOGLU3, Guray SAYDAM8, Guner Hayri OZSAN3, Fatih DEMIRKAN3, Levent UNDAR1
1Akdeniz University, Faculty of Medicine, Department of Hematology
2Antalya Training and Research Hospital, University of Health Sciences, Department of Hematology
3Dokuz Eylul University, Faculty of Medicine, Department of Hematology
4Kocaeli University, Faculty of Medicine, Department of Hema
5Medstar Antalya Hospital, Department of Hematology and Stem Cell Transplant Unit
6Istanbul Training and Research Hospital, University of Health Sciences, Department of Hematology
7Istanbul University, Cerrahpasa Faculty of Medicine, Department of Hematology
8Ege University, Faculty of Medicine, Department of Hematology
9Hacettepe University, Faculty of Medicine, Department of Hematology
10Mersin University, Faculty of Medicine, Department of Hematology
11Near East University, Faculty of Medicine, Department of Hematology
Keywords: Ibrutinib, Central nervous system lymphoma, Relapsed/refractory, Maintenance, Aspergillosis
Despite recent therapeutic advances, the prognosis of patients with relapsed/refractory (RR) primary (PCNSL) and secondary central nervous system lymphoma (SCNSL) remains poor. Therefore, the need for new treatment options in CNSL continues. Ibrutinib has been used in clinical trials for CNSL in recent years. However, there is no real-life data on this subject yet. We retrospectively evaluated the efficacy of ibrutinib alone or in combination with various treatment options in 39 patients, 21 with PCNSL and 18 with SCNSL. The median age was 62 years and the overall response rate (ORR) was 59%. The median overall survival (OS) was four months for all patients and 13 months for responder patients (p< 0.001). Invasive aspergillosis occurred in 10.2% of the patients. Lactate dehydrogenase activity, response to treatment, and the presence of the invasive fungal infection were prognostic factors affecting OS on the ibrutinib therapy (p= 0.04, p= 0.02, and p= 0.048, respectively). There was no significant difference in prognosis between the IBR monotherapy and IBR combination groups. Compared to early-phase clinical studies, lower ORR, shorter OS, and a higher incidence of invasive fungal infections were observed in this real-life study of ibrutinib which was used alone or in a combination regimen in patients with RR PCNSL and SCNSL.
Utku ILTAR1, Ozan SALIM1, Unal ATAS2, Ece VURAL1, Fadime Nurcan ALHAN1, Orhan Kemal YUCEL1, Hasan SOZEL1, Serkan GUVEN3, Ayfer GEDUK4, Burak DEVECI5, Istemi SERIN6, Tugrul ELVERDI7, Fatma Keklik KARADAG8, Volkan KARAKUS2, Umit Yavuz MALKAN9, Anil TOMBAK10, Turgay ULAS11, Pinar TARKUN4, Ahmet Emre ESKAZAN7, Inci ALACACIOGLU3, Guray SAYDAM8, Guner Hayri OZSAN3, Fatih DEMIRKAN3, Levent UNDAR1
1Akdeniz University, Faculty of Medicine, Department of Hematology
2Antalya Training and Research Hospital, University of Health Sciences, Department of Hematology
3Dokuz Eylul University, Faculty of Medicine, Department of Hematology
4Kocaeli University, Faculty of Medicine, Department of Hema
5Medstar Antalya Hospital, Department of Hematology and Stem Cell Transplant Unit
6Istanbul Training and Research Hospital, University of Health Sciences, Department of Hematology
7Istanbul University, Cerrahpasa Faculty of Medicine, Department of Hematology
8Ege University, Faculty of Medicine, Department of Hematology
9Hacettepe University, Faculty of Medicine, Department of Hematology
10Mersin University, Faculty of Medicine, Department of Hematology
11Near East University, Faculty of Medicine, Department of Hematology
Keywords: Ibrutinib, Central nervous system lymphoma, Relapsed/refractory, Maintenance, Aspergillosis
Despite recent therapeutic advances, the prognosis of patients with relapsed/refractory (RR) primary (PCNSL) and secondary central nervous system lymphoma (SCNSL) remains poor. Therefore, the need for new treatment options in CNSL continues. Ibrutinib has been used in clinical trials for CNSL in recent years. However, there is no real-life data on this subject yet. We retrospectively evaluated the efficacy of ibrutinib alone or in combination with various treatment options in 39 patients, 21 with PCNSL and 18 with SCNSL. The median age was 62 years and the overall response rate (ORR) was 59%. The median overall survival (OS) was four months for all patients and 13 months for responder patients (p< 0.001). Invasive aspergillosis occurred in 10.2% of the patients. Lactate dehydrogenase activity, response to treatment, and the presence of the invasive fungal infection were prognostic factors affecting OS on the ibrutinib therapy (p= 0.04, p= 0.02, and p= 0.048, respectively). There was no significant difference in prognosis between the IBR monotherapy and IBR combination groups. Compared to early-phase clinical studies, lower ORR, shorter OS, and a higher incidence of invasive fungal infections were observed in this real-life study of ibrutinib which was used alone or in a combination regimen in patients with RR PCNSL and SCNSL.
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