pci-32765 and Cryptococcosis

We report a case of

Topics: Adenine; Aged; Amphotericin B; Antibodies, Monoclonal, Murine-Derived; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Cryptococcosis; Cryptococcus neoformans; Cyclophosphamide; Doxorubicin; Empyema, Pleural; Fluconazole; Humans; Lymphoma, Large B-Cell, Diffuse; Male; Piperidines; Prednisone; Pyrazoles; Pyrimidines; Rituximab; Vincristine

We report a case of invasive fungal infection (IFI) that ensued during ibrutinib treatment. A 79-year-old female was diagnosed with chronic lymphocytic leukemia seven years prior. She had undergone chemotherapy at the ages of 72 and 75. Subsequently, she was placed on ibrutinib treatment at the age of 79. On the 119th day after the ibrutinib treatment initiation, she was admitted to our hospital with the complaints of frequent urination and hematuria, and three days later, she died of disseminated cryptococcosis.IFIs should be considered in the event of infections that develop early after the ibrutinib treatment initiation.

Topics: Adenine; Aged; Cryptococcosis; Female; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Piperidines

Invasive fungal diseases and especially Cryptococcus neoformans infections are increasingly reported in patients with hematological malignancies receiving ibrutinib, a Bruton's tyrosine kinase inhibitor.. We reported three additional cases and reviewed 16 previous published cases together with cases from the international pharmacovigilance database.. Patients were mainly treated for chronic lymphocytic leukemia. Cryptococcosis mostly occurred during the first six months (66%) and especially the first two months (44%) of treatment. Clinical presentation is often pulmonary (68%) and the outcome is usually favorable despite ibrutinib continuation.. Clinicians must be aware of this infection in patients with hematological malignancies on ibrutinib.

Topics: Adenine; Cryptococcosis; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Piperidines; Protein Kinase Inhibitors; Risk Factors

Topics: Adenine; Aged, 80 and over; Cryptococcosis; Dermatomycoses; Female; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Piperidines; Pyrazoles; Pyrimidines

Cryptococcal infections are responsible for significant morbidity and mortality in immunocompromised patients. Reports of these infections in patients on small molecular kinase inhibitors have not been widely reported in clinical trials. We describe one case of cryptococcal meningoencephalitis and one case of cryptococcal pneumonia in two patients who were receiving ibrutinib for chronic lymphocytic leukemia. Despite different sites of cryptococcal infection, both patients had similar presentations of acute illness. Patient 1 was worked up for health care-associated pneumonia, as well as acute sinusitis prior to the diagnosis of cryptococcal meningoencephalitis. He also had a more complex past medical history than patient 2. Patient 2 developed atrial fibrillation from ibrutinib prior to admission for presumed health care-associated pneumonia. Cryptococcal antigen testing was done sooner in this patient due to patient receiving high-dose steroids for the treatment of underlying hemolytic anemia. We conclude that patients who develop acute illness while receiving ibrutinib should be considered for cryptococcal antigen testing.

Topics: Adenine; Aged; Cryptococcosis; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Piperidines; Protein Kinase Inhibitors; Pyrazoles; Pyrimidines

Chronic lymphocytic leukemia (CLL) is a disorder of B cells that affects humoral as well as cell-mediated immunity. Protection against cryptococcal infections is mounted by an intricate and synchronized interplay of both integral arms of immunity. Whether CLL or small molecule tyrosine kinase inhibitors are independently predisposing hosts to cryptococcal infections remain to be explored. Herein, we present a report of a patient who developed disseminated cryptococcosis while receiving ibrutinib therapy for CLL in the salvage setting. We further present relevant literature available thus far on the topic and discuss immunologic mechanisms that may be involved in the fungal pathogenesis in such patients.

Topics: Adenine; Aged, 80 and over; Central Nervous System Neoplasms; Cryptococcosis; Humans; Male; Piperidines; Pyrazoles; Pyrimidines

Topics: Adenine; Agammaglobulinaemia Tyrosine Kinase; Cryptococcosis; Fatal Outcome; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Piperidines; Pyrazoles; Pyrimidines

Topics: Adenine; Aged; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Cryptococcosis; Female; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Magnetic Resonance Imaging; Meningoencephalitis; Piperidines; Protein Kinase Inhibitors; Pyrazoles; Pyrimidines; Waldenstrom Macroglobulinemia

Topics: Adenine; Aged; Cryptococcosis; Humans; Immunocompromised Host; Lung Diseases, Fungal; Lymphoma, Mantle-Cell; Maintenance Chemotherapy; Male; Neoplasm Staging; Piperidines; Positron Emission Tomography Computed Tomography; Protein Kinase Inhibitors; Pyrazoles; Pyrimidines; Solitary Pulmonary Nodule; Tomography, X-Ray Computed