17p deletion

Ibrutinib as First-Line Therapy in High-Risk Chronic Lymphocytic Leukemia: Case Reports

AUTOIMMUNE THROMBOCYTOPENIA , ,

NV Kurkina, EA Repina

NP Ogarev National Research Mordovia State University, 68 Bolshevistskaya str., Saransk, Russian Federation, 430005

For correspondence: Nadezhda Viktorovna Kurkina, MD, PhD, 26А Ul’yanova str., Saransk, Russian Federation, 430032; Tel.: +7(927)172-48-63; e-mail: nadya.kurckina@yandex.ru

For citation: Kurkina NV, Repina EA. Ibrutinib as First-Line Therapy in High-Risk Chronic Lymphocytic Leukemia: Case Reports. Clinical oncohematology. 2021;14(4):488–95. (In Russ).

DOI: 10.21320/2500-2139-2021-14-4-488-495

ABSTRACT

In the selection of the optimal specific therapy in chronic lymphocytic leukemia (CLL), a crucial role is played by the determination of risk groups. The CLL International Prognostic Index takes account of unfavorable del(17p), del(11q) cytogenetic abnormalities, and/or TP53 gene mutations as well as the mutation status of immunoglobulin heavy chain variable region genes (IGHV). The absence of IGHV gene mutations is often associated with such prognostically unfavorable genetic markers as del(17p), del(11q), trisomy 12, and TP53 mutation. The combinations of this kind affect the prognosis and overall survival rate. Besides, in high-risk CLL the efficacy of therapy is rather low and the development of refractoriness is possible. In such patients the use of Bruton tyrosine kinase inhibitor as first-line therapy considerably increases the probability of long-term remission. The present paper provides the analysis of clinical and hematological efficacy and tolerance of ibrutinib as first-line therapy in high-risk CLL. Ibrutinib shows high efficacy and low toxicity. The use of ibrutinib as first-line therapy effectively reduces the probability of CLL progression, which is especially critical in high-risk patients, i.e., with 17p deletion and TP53 gene mutation.

Keywords: chronic lymphocytic leukemia, high-risk group, 17p deletion, TP53 gene mutation, ibrutinib, efficacy, toxicity.

Received: March 15, 2021

Accepted: August 30, 2021

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High-risk chronic lymphocytic leukemia: history, definition, diagnosis, and management

DIAGNOSIS AND TREATMENT OF LYMPHOID TUMORS , ,

E.A. Nikitin, A.B. Sudarikov

FSBI «Haematological Research Center» Russian Ministry of Health, Moscow, Russian Federation

 ABSTRACT

High-risk chronic lymphocytic leukemia is an emerging concept that was first established in fludarabine era. While fludarabine and fludarabine-containing regimens are highly effective in the majority of patients, a small subgroup of patients show poor response to standard regimens. The prognosis of these patients is dismal with a median overal survival of 2 – 3 years. The article present historical review and modern definition of high risk CLL, describes known molecular mechanisms of refractoriness to fludarabine and focuses on different treatment approaches.

 

Keywords: chronic lymphocytic leukemia, TP53, 17p deletion, fludarabine

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