Oral Targeted Inhibitors Effective for CLL Patients With Severe Renal Dysfunction

Oral target inhibitors are a viable treatment option for patients with chronic lymphocytic leukemia (CLL) with serve renal dysfunction, according to a study presented at the SOHO 2024 Annual Meeting.

Researchers conducted an electronic search and chart review of 127 patients at 70 VA centers who were treated with oral targeted agents from 2013 to 2022. The population of interest all had an eGFR <30 ml/min/1.73 m2 during treatment. Patients with cases of acute kidney injury were excluded from analysis. The researchers analyzed the findings using Fisher’s exact test, logistic regression, and Cox regression.

The oral targeted treatments included ibrutinib, acalabrutinib, zanubrutinib, venetoclax, and idelalisib, with 70% starting at FDA-recommended doses. The researchers noted that dose reductions due to toxicity were common, particularly with ibrutinib. The findings suggest that renal dysfunction did not significantly improve with treatment, and dose adjustments did not impact treatment efficacy nor survival rates. The investigators further noted that failure and cirrhosis were significant factors affecting survival.

Oral targeted inhibitors offer a viable treatment for patients with CLL and severe renal dysfunction, although careful lab monitoring and potential dose modifications for tolerability are required. However, CLL treatment is unlikely to improve severe renal dysfunction, highlighting the need for further research in this area.

Reference

Yoo K.  Tumor-Specific Reactive Oxygen Species Accelerators Improve Chimeric Antigen Receptor T Cell Therapy in B
Cell Malignancies Abstract #CLL-020. Presented at the Society of Hematologic Oncology Meeting 2024; September 4-7, 2024; Houston, Texas.