1. Ristocetin-induced platelet aggregation for monitoring of bleeding tendency in CLL treated with ibrutinib
- Author
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Kazianka, L, Drucker, C, Skrabs, C, Thomas, W, Melchardt, T, Struve, S, Bergmann, M, Staber, P B, Porpaczy, E, Einberger, C, Heinz, M, Hauswirth, A, Raderer, M, Pabinger, I, Thalhammer, R, Egle, A, Wendtner, C-M, Follows, G, Hoermann, G, Quehenberger, P, Jilma, B, and Jaeger, U
- Abstract
Bleeding because of impaired platelet function is a major side effect of the Bruton’s tyrosine kinase (BTK) inhibitor ibrutinib. We quantitatively assessed ristocetin-induced platelet aggregation (RIPA) in 64 patients with chronic lymphocytic leukemia (CLL) under ibrutinib at 287 time points. Eighty-seven bleeding episodes in 39 patients were registered (85 Common Toxicity Criteria (CTC) grade 1 or 2, 2 CTC grade 3) during a median observation period of 10.9 months. At times of bleeding, RIPA values were significantly lower (14 vs 28 U; P<0.0001). RIPA was impaired in patients receiving concomitant antiplatelet therapy or anticoagulation (14 vs 25 U, P=0.005). A gradual decline of median RIPA values was observed with increasing bleeding severity. Importantly, no CTC grade 2 or 3 bleeding were observed with RIPA values of >36 U. Sequential monitoring indicated a decrease of RIPA values from a median of 17 to 9 U within 2 weeks after initiation of treatment as well as an increase above the critical threshold of 36 U within 7 days when ibrutinib was paused. Low RIPA values were similar during treatment with another BTK inhibitor, CC292. Quantitative assessment of platelet function is a practical tool to monitor bleeding tendency under BTK-inhibitor therapy.
- Published
- 2017
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