Abstract: SA-PO169
Ibrutinib-Induced Acute Tubular Injury: A Case Series and Review of the Literature
Session Information
- Onco-Nephrology: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- Bansal, Anip, University of Colorado, Aurora, Colorado, United States
- Manohar, Sandhya, Mayo Clinic, Rochester, Minnesota, United States
- Sakhiya, Vipulbhai, Northwell Health, Great Neck, New York, United States
- Wanchoo, Rimda, Zucker School of Medicine at Hofstra Northwell, Great Neck, New York, United States
- Jhaveri, Kenar D., Zucker School of Medicine at Hofstra Northwell, Great Neck, New York, United States
Introduction
CLL is the most prevalent form of leukemia in adults. Treatment with Bruton tyrosine kinase pathway inhibitor, ibrutinib has revolutionized its treatment. HTN and tumor lysis syndrome (TLS) with ibrutinib are known but acute tubular injury (ATI) has not been reported. Here, we describe 2 cases of biopsy proven ATI associated with ibrutinib and review its nephrotoxicity.
Case Description
Case 1: 63 year old man with CLL was started on ibrutinib with excellent disease control for the past 3.5 years. His baseline creatinine was 1.4 mg/dl but since starting therapy had slowly increased to 2.0 mg/dl. Non-invasive workup was unremarkable and hence underwent a kidney biopsy. This showed mild ATI on a background of mild chronicity. There was suspicion for low grade vascular injury on light microscopy but no endothelial injury was noted on electron microscopy. Clinically he had no HTN nor any lab evidence of microangiopathic hemolysis. Considering the unfavorable cytogenetics of his CLL and good disease control decision was made to continue ibrutinib and at 6 month follow up his creatinine continues to be stable.
Case 2: 59 year old man with CLL was started on ibrutinib 6 months before nephrology consultation. His baseline creatinine was 1.1 mg/dL but with treatment slowly increased to a peak of 2.71 mg/dL. His BP was normal. Non-invasive workup was unremarkable and hence underwent a kidney biopsy which showed ATI alone. Based on absence of any other etiology of his kidney injury a diagnosis of ibrutinib associated ATI was made and ibrutinib was discontinued. One month later his serum creatinine had improved to 2.37mg/dL.
Discussion
We reviewed the FAERS quarterly legacy data file for ibrutinib associated adverse events (third quarter of 2014 to fourth quarter of 2018 ) and overall >600 events were reported of which >25% were for AKI.
Conclusion: In addition to TLS and HTN, ATI can be seen with ibrutinib. Hematologists and nephrologists need to be aware of this rare but important toxicity of ibrutinib.