Luca Laurenti, Marta Coscia, Claudia Ielo, Gianluigi Reda, Antonio Cuneo, Gian Matteo Rigolin, Gianluca Gaidano, Giovanni Del Poeta, Massimo Gentile, Caterina Stelitano, Livio Trentin, Giuseppe Gentile, Lorenzo De Paoli, Annamaria Giordano, Valerio Guarente, Paolo Sportoletti, Stefania Ciolli, Robin Foà, Candida Vitale, Alessandro Noto, Andrea Visentin, Maurizio Martelli, Francesca Romana Mauro, Alessandra Tedeschi, Corrado Girmenia, Annalisa Chiarenza, Roberta Murru, Anna Maria Frustaci, Diana Giannarelli, Luciano Levato, and Stefano Molica
Ibrutinib represents extraordinary progress in the treatment of chronic lymphocytic leukemia (CLL). However, treatment-related adverse events limit the benefit of this agent. This observational, multicenter study focused on the incidence, risk factors, and prognostic impact of infections in 494 patients with CLL treated with an ibrutinib-based treatment. Ibrutinib was given to 89 (18%) previously untreated patients (combined with rituximab, 24) and 405 (82%) relapsed/refractory patients. Pneumonia (PN), grade ≥3 non-opportunistic infections (NOI), and opportunistic infections (OI) were recorded in 32% of patients with an overall incidence rate per 100 person-year of 15.3% (PN, 10%, NOI, 3.3%, OI, 2%). Infections were the reason for the permanent discontinuation of ibrutinib in 9% of patients. Patients who experienced pneumonia or a severe infection showed a significantly inferior survival than those who were infection-free (p <, 0.0001). A scoring system based on the three factors associated with a significant and independent impact on infections—PN or severe infection in the year before starting ibrutinib, chronic obstructive pulmonary disease, ≥2 prior treatments—identified patients with a two- to threefold increase in the rate of infections. In conclusion, the results of this study highlight the adverse impact of infectious events on the outcomes of CLL patients treated with ibrutinib.