Diffuse Lung Disease |

Ibrutinib Induced Interstitial Lung Disease FREE TO VIEW

Reza Samad, MD; Jean Santamauro, MD; Marc Feinstein, MD
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Memorial Sloan Kettering Cancer Center, New York, NY

Chest. 2015;148(4_MeetingAbstracts):365A. doi:10.1378/chest.2281807
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SESSION TITLE: Diffuse Lung Disease Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Ibrutinib is an oral Bruton's tyrosine kinase inhibitor commonly associated with upper respiratory infection and pneumonia. We describe a case of interstitial lung disease (ILD), likely induced by ibrutinib.

CASE PRESENTATION: A 85 year-old male was transferred to our facility from an outside hospital (OH) with five weeks of progressive respiratory failure, hypoxemia, and a chest x-ray concerning for pneumonia. He initially received broad antibiotic coverage with cefepime, vancomycin, azithromycin, and trimethoprim/sulfamethoxazole, as well as empiric steroids. When sputum cultures grew MRSA, antibiotics were changed to linezolid and levofloxacin. Attempts at a steroid taper were limited by worsening respiratory distress. By the fourth week of his hospitalization, his regimen included prednisone 40mg BID, and prophylactic atovaquone, and his oxygen demands had decreased sufficiently to allow his transfer from the ICU. The patient had a history of mantle cell lymphoma (MCL) diagnosed 2.5 years earlier, which had been treated with ofatumumab and bendamustine. Three months prior to presentation he was started on ibrutinib for progression of disease. He was a former smoker, having quit 50 years ago. Physical exam demonstrated resting hypoxemia, and bibasilar rales. A chest x-ray demonstrated resolution of bilateral opacities seen on an earlier chest x-ray at OH. A high-resolution CT chest revealed bilateral lower lobe predominant extensive bronchiectasis, with scattered ground glass opacities and subpleural honeycombing, new compared to imaging 5 months earlier (see image). Workup for interstitial lung disease did not demonstrate markers for connective tissue disease or hypersensitivity pneumonitis. Bronchoscopy with bronchoalveolar lavage was not diagnostic. Surgical lung biopsy was deferred considering his comorbidities. With a slow steroid taper and intensive pulmonary hygiene, the patient improved sufficiently for discharge. Three months later, he required no supplemental oxygen, and required only a minimal steroid dose.

DISCUSSION: Ibrutinib is an oral Bruton's tyrosine kinase inhibitor, approved for the treatment of MCL and chronic lymphocytic leukemia. Pulmonary adverse reactions are common, and are mainly dyspnea, cough, upper respiratory infection or pneumonia. We describe a case of steroid responsive ILD, likely induced by ibrutinib.

CONCLUSIONS: Consideration should be given to ibrutinib as a cause of drug-induced ILD.

Reference #1: .

DISCLOSURE: The following authors have nothing to disclose: Reza Samad, Jean Santamauro, Marc Feinstein

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