Abstracts Clinical Lymphoma, Myeloma & Leukemia September 2023 S322 CLL-147 Chronic Hepatitis B Infection Management During Long‑Term Follow‑Up of Chronic Lymphocytic Leukemia (CLL) Treated With Multiple Lines of Chemoimmunotherapy, Including Ibrutinib Bahar Sevgili MD1, Ajda Güneş MD1, Nur Soyer MD1, Fahri Şahin MD1, Nevin Oruç MD2, Güray Saydam MD1 1Ege University, Faculty of Medicine, Department of Hematology, Izmir, Turkey. 2Ege University, Faculty of Medicine, Department of Gastroenterology, Izmir, Turkey Background: Hepatitis B virus (HBV) reactivation may occur in B cell dysfunction, especially in those B cells that have previously met with HBV surface antigen (HBsAg), despite prior acquired immunity. Ibrutinib is a Bruton’s tyrosine kinase inhibitor (BTKi) that regulates B-cell signaling, resulting in B-cell maturation. HBV reactivation during treatment with tyrosine kinase inhibitors is still a dilemma; there is little knowledge about how to protect against acute reactivation of HBV. Objective: To present a case report of chronic HBV reactivation during ibrutinib treatment. Case Report: A 75-year-old man previously diagnosed with Rai stage 2 CLL and naturally immunized against HBV was admitted to our clinic. In May 2017, a rituximab + chlorambucil (R-Cl) protocol was administered with tenofovir disoproxil fumarate prophylaxis. After 6 cycles of chemotherapy, he was in remission. No HBV reactivation occurred during prophylaxis or the treatment-free follow-up interval. Three years after his last dose of chemotherapy, in September 2020, he had weight loss, rapidly growing lymphadenopathy, and anemia. Due to a relatively low performance status score, ibrutinib 420 mg/d was administered. After the ninth cycle of ibrutinib, elevated liver enzymes were detected. His HBV DNA level was increased, so entecavir was administered; after the third cycle, the HBV DNA level did not decrease enough, so his treatment was switched to tenofovir alafenamide fumarate (TAF). After 3 cycles of TAF, continued follow up for chronic inactive HBV and CLL. Discussion: Ibrutinib has a potential role in B-cell signaling, causing alteration of cellular immunity. On the other hand, ibrutinib also facilitates B-cell maturation, allowing immunomodulation of T cells, which are also considered amendatory for the immune system. Primary or secondary prophylaxis for HBV, especially for carriers before initiation of ibrutinib, is still controversial according to local and international guidelines. An individualized approach and risk assessment is still considered the best option for HBV prophylaxis. Keywords: CLL, chronic lymphocytic leukemia, hepatitis B virus, viral infection/reactivation, ibrutinib, Bruton’s tyrosine kinase inhibitor, case CLL-148 Case Report: Combined Chronic Lymphocytic Leukemia and Primary Immune Failure Seda Yılmaz MD1, Ersin Musluk MD2, Emel Atayık MD3 1Adult Hematology Clinic, Konya City Hospital, Konya, Turkey. 2Internal Medicine Clinic, Konya City Hospital, Konya, Turkey. 3Adult Allergy and Immunology Department, Konya City Hospital, Konya, Turkey Objective: To highlight the coexistence of chronic lymphocytic leukemia (CLL) and primary immunodeficiency (PID) and emphasize the importance of evaluating these patients simultaneously for immunological abnormalities and appropriate treatment selection. Case Report: A 49-year-old man presented with lymph node swelling; he had a history of recurrent respiratory tract infections since childhood and recurrent skin infections as an adult. Laboratory findings revealed leukocytosis, lymphocytosis, and low levels of immunoglobulins. The patient was diagnosed with CLL based on the laboratory and clinical findings. Consultation with the immunology department confirmed the concurrent presence of PID. Treatment with venetoclax and rituximab was initiated. Imaging studies showed no lymphadenopathy after 12 months of venetoclax treatment, and the complete blood count and immunoglobulin levels improved. The patient received intravenous immunoglobulin (IVIG) treatment for 1 year; during this year, he developed a lobar pneumonia but achieved complete recovery with nonspecific antibiotic therapy. No prophylactic antibiotics were required during follow up. Conclusion: This case report emphasizes the importance of evaluating patients with CLL for concurrent PID and incorporating IVIG treatment in patients with a history of recurrent infections. Simultaneous assessment of immunological abnormalities in CLL patients can guide treatment selection, ensuring appropriate management of both CLL and PID. Future research is needed to better understand the relationship between CLL and PID and optimize treatment strategies for patients with this comorbidity. Keywords: chronic lymphocytic leukemia, primary immunodeficiency, immunoglobulin replacement, case CLL-194 Ibrutinib for Treatment of Relapsed‑Refractory Chronic Lymphocytic Leukemia: A Matching‑Adjusted Indirect Comparison of 3 Randomized Phase III Trials Jan Burger MD, PhD1, Paolo Ghia MD, PhD2, Talha Munir MD3, John F. Seymour MD, MBBS, PhD4, Kerry Rogers MD5, Hsin-Hui Huang PhD6, Carol Moreno MD, PhD7, Lynne Neumayr MD6, Christopher Abbazio PharmD6, Jeff P. Sharman MD8 1The University of Texas MD Anderson Cancer Center, Houston, USA. 2Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy. 3St James’s University Hospital, Leeds, United Kingdom. 4Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia. 5The Ohio State University, Columbus, OH, USA. 6AbbVie, North Chicago, IL, USA. 7Hospital de la Santa Creu i Sant Pau, Josep Carreras Leukemia Research Institute, Autonomous University of Barcelona, Barcelona, Spain. 8Willamette Valley Cancer Institute and Research Center, Eugene, OR, USA
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