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Therapeutic approaches and drug-resistance in chronic lymphocytic leukaemia

Cancer Drug Resistance 2020年第3期3卷 532-549页

作者： Narjis Fatima Kyle R.Crassini Lauren Thurgood Yandong Shen Richard I.Christopherson Bryone Kuss Stephen P.Mulligan Oliver Giles Best Kolling Institute of Medical Research University of SydneyRoyal North Shore HospitalSydneyNSW 2065Australia. School of Life and Environmental Sciences University of SydneySydney NSW 2008Australia. College of Medicine and Public Health Flinders UniversityBedford ParkAdelaideSA 5042Australia.

The treatment of chronic lymphocytic leukaemia has been revolutionised in recent years,first by the introduction of chemoimmunotherapy regimens and subsequently by the development of drugs,including ibrutinib,idelalisib and venetoclax,that target components of the B-cell receptor signalling pathway or B-cell lymphoma 2 family of *** high initial response rates in patients treated with chemoimmunotherapy or targeted agents,a significant proportion of patients relapse with progressive and refractory *** a subset of these patients,drug resistance has been associated with specific genetic lesions or activation of alternate pro-survival ***,the mechanisms that confer drug resistance in the remainder of the patients with refractory disease have yet to be fully *** this review,we discuss our current understanding of the mechanics of drug resistance in chronic lymphocytic leukaemia and describe how this knowledge may aid in rationalising future treatment strategies to prevent the development of refractory or aggressive transformation of the disease.

关键词： chronic lymphocytic leukaemia drug resistance targeted cancer therapy

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Pituitary macroadenoma apoplexy as a rare complication of Bruton tyrosine kinase inhibitor in chronic lymphoid leukaemia

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Chinese Neurosurgical Journal 2023年第4期9卷 320-325页

作者： Aysha Gomaa Robert Skelly East Sussex Healthcare NHS Trust EastbourneUK East Suffolk and North Essex NHS Foundation Trust ColcchesterUK

Background Pituitary apoplexy is a neurosurgical emergency and is a known yet rare complication of pituitary *** typically present with visual field defects,headache and altered *** are multiple risk factors for this complication and a thorough drug history is essential to exclude iatrogenic causes of *** present an extremely rare case of newly diagnosed pituitary insufficiency unveiled by ibrutinib therapy(a Bruton tyrosine kinase inhibitor).Furthermore,after initial withdrawal of ibrutinib because of the erroneous diagnosis of Syndrome of Inappropriate Antidiuretic Hormone Secretion(SIADH),its re-administration led to the development of classical pituitary apoplexy 4 months after treatment was *** presentation A male patient in his 60s with a background of chronic lymphocytic leukaemia(CLL)on ibrutinib and venetoclax presents with acute confusion and deranged *** is found to be hyponatraemic and is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone Secretion(SIADH)and treated with fluid *** represents again 3 weeks later with hyponatraemia and further investigations reveal pituitary insufficiency and *** was restarted on ibrutinib and venetoclax at the time of *** months later,he presents with sudden retro-orbital headache associated with *** findings include cranial nerve III,IV and XI ***’s visual field examination revealed a left visual field index(VFI)of only 1%while the right was 64%with temporal *** pupils were mid-dilated and poorly reactive to *** pituitary with contrast showed features of pituitary apoplexy and optic nerve *** was urgently referred to the neurosurgical team and underwent an emergency trans-sphenoidal hypophysectomy with circumferential excision of the ***-operative recovery was uneventful with marked improvement in vision *** patient was restarted on ibruti

关键词： Pituitary apoplexy Pituitary macroadenoma chronic lymphocytic leukaemia Chemotherapy

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