Ibrutinib
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Tumour lysis syndrome: case report A 70-year-old man developed tumour lysis syndrome during treatment with ibrutinib for chemotherapy-resistant chronic lymphocytic leukaemia and small lymphocytic lymphoma (CLL/SLL). The man, who had a history of hypertension and CLL/SLL, started receiving bendamustine and rituximab, but exhibited a poor response. He was taking various medications, concomitantly. After six weeks, he was started on oral ibrutinib 420 mg/day. Within three days, he developed progressive shortness of breath, decreased urine output and weakness. Upon admission, laboratory tests results showed uric acid 1368 mmol/L, BUN 54 mmol/L, potassium 7.9 mmol/L, bicarbonate 11 mmol/L, creatinine 0.404 mmol/L, potassium 7.9 mmol/L, calcium 0.85 mmol/L, phosphorus 6.9 mmol/L, total bilirubin 7 nmol/L, AST 16 U/L, ALT 21 U/L and creatine kinase 25 U/L. Urinalysis was found to be positive for protein and blood. Renal ultrasonography exhibited normal kidneys. Based on these findings, a diagnosis of tumour lysis syndrome due to hyperuricemia and acute kidney injury was made. The man’s treatment with ibrutinib was discontinued. He was treated with rasburicase and haemodialysis. Hence, a dramatic improvement in phosphorus levels, kidney function and uric acid were noted. CT abdomen showed 50% shrinkage of bulky lymphadenopathy, which was consistent with a partial response to ibrutinib. At the time of discharge, his phosphorus was of 1.13 mmol/l, creatinine was of 0.106mmol/L and uric acid was less than 0.030 mmol/L. Brener ZZ, et al. Bruton’s tyrosine kinase inhibitors and the kidney: Focus on ibrutinib. Journal of Oncology Pharmacy Practice 26: 1735-1737, No. 7, 13 Feb 2020. Available 803518989 from: URL: http://doi.org/10.1177/1078155220904406
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Reactions 5 Dec 2020 No. 1833
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