Patients with B-cell lymphomas receiving Bruton tyrosine kinase (BTK) inhibitor monotherapy have a statistically significant increased risk of infections, particularly upper respiratory tract infections (URTIs), according to a recent publication in Hematological oncology.1 These patients should be monitored proactively and closely, even if the physicians treating them implement prophylactic measures, the authors explain.
Respiratory tract infections may occur in patients with CLL taking BTK inhibitors image credit: Worldillustrator – stock.adobe.com
These tactics can include everything from the use of prophylactic antibiotics to vaccinations against common pathogens, and certainly educating patients on hygiene practices to minimize exposure to infections. It is also important to identify subgroups of patients whose risk of infection is even further increased, the authors noted, necessitating further refinement of BTK inhibitor treatment plans.
include B-cell lymphomas chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), mantle cell lymphoma, diffuse large B-cell lymphoma, marginal zone lymphoma, follicular lymphoma, multiple myeloma and Waldenström macroglobulinemia. BTK inhibitors target malignant cells in these diseases, but this does not eliminate the possibility of off-target effects, including effects that may compromise the integrity of the immune system and increase susceptibility to infections.2
In their review/meta-analysis, the team included 18 reports on 12 studies (one phase 2, the rest phase 3). All studies were randomized controlled trials: each included patients with B-cell lymphoma treated with BTK inhibitor monotherapy, and each reported on infections in those patients.
By the numbers
The median age of patients in the studies ranged between 64 and 73 years. The authors calculated the risk ratio (RR) using a random effect model in R Statistical Software.
The overall pooled RR for URTIs of any grade associated with BTK inhibitor treatment was statistically significant: 1.55 (95% CI: 1.22-1.97; P