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CLINICAL NEWS
ibrutinib; the other five deaths occurred after
the patients discontinued ibrutinib.
In an accompanying exploratory
biomarker analysis, the researchers found
that pro-inflammatory, chemotactic, and
fibrotic factors (including the cGVHD-
associated biomarkers IFNγ, TNFα, IP-10,
and CXCL9) decreased following ibrutinib
therapy, “suggesting that ibrutinib could be
impacting resolution of allogeneic inflam-
mation at the cellular level,” the authors
Two patients had a relapse of their
underlying malignancy (one with acute
lymphocytic leukemia and one with
prolymphocytic leukemia). AEs led to
dose reductions in 13 patients (31%) and
treatment discontinuation in 14 patients
(33%).
Seven patients died during the study.
Two deaths were related to AEs (multilobu-
lar pneumonia and bronchopulmonary
aspergillosis) while the patients were on
The authors report financial support from
Pharmacyclics LLC.
explained.
The study was limited by its single-arm
design and small patient population. The
authors added that a randomized, controlled
trial comparing upfront treatment with
ibrutinib or high-dose steroids in patients
with cGVHD is underway.
The study was supported by Pharma-
cyclics LLC, a subsidiary of AbbVie (the
manufacturers of ibrutinib).
REFERENCE
Miklos D, Cutler CS, Arora M, et al. Ibrutinib for chronic graft-versus-host
disease after failure of prior therapy. Blood. 2017 September 18. [Epub
ahead of print]
T:7”
REVLIMID ® [lenalidomide] capsules, for oral use
Table 5: All Adverse Reactions in ≥5.0% and Grade 3/4 Adverse Reactions in ≥ 1.0% of Patients in the REVLIMID Vs Placebo Arms*
Maintenance Study 1
All Adverse Reactions [a]
Body System
Adverse Reaction
REVLIMID
(N=224)
n (%)
Maintenance Study 2
Grade 3/4 Adverse
Reactions [b]
Placebo
(N=221)
n (%) REVLIMID
(N=224)
n (%)
All Adverse Reactions [a]
Grade 3/4 Adverse
Reactions [b]
Placebo
(N=221)
n (%) REVLIMID
(N=293)
n (%) Placebo
(N=280)
n (%) REVLIMID
(N=293)
n (%) Placebo
(N=280)
n (%)
Blood and lymphatic system disorders
Neutropenia c % 177 ( 79.0) 94 ( 42.5) 133 ( 59.4) 73 ( 33.0) 178 ( 60.8) 33 ( 11.8) 158 ( 53.9) 21 ( 7.5)
Thrombocytopenia c % 162 ( 72.3) 101 ( 45.7) 84 ( 37.5) 67 ( 30.3) 69 ( 23.5) 29 ( 10.4) 38 ( 13.0) 8 ( 2.9)
Leukopenia
c
51 ( 22.8) 25 ( 11.3) 45 ( 20.1) 22 ( 10.0) 93 ( 31.7) 21 ( 7.5) 71 ( 24.2) 5 ( 1.8)
Anemia 47 ( 21.0) 27 ( 12.2) 23 ( 10.3) 18 ( 8.1) 26 ( 8.9) 15 ( 5.4) 11 ( 3.8) 3 ( 1.1)
Lymphopenia 40 ( 17.9) 29 ( 13.1) 37 ( 16.5) 26 ( 11.8) 13 ( 4.4) 3 ( 1.1) 11 ( 3.8) 2 ( 0.7)
1 ( 0.4) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) 12 ( 4.1) 1 ( 0.4) 7 ( 2.4) 1 ( 0.4)
39 ( 17.4) 34 ( 15.4) 39 ( 17.4) 34 ( 15.4) 7 ( 2.4) 1 ( 0.4) 5 ( 1.7) 1 ( 0.4)
Upper respiratory tract
infection e 60 ( 26.8) 35 ( 15.8) 7 ( 3.1) 9 ( 4.1) 32 ( 10.9) 18 ( 6.4) 1 ( 0.3) 0 ( 0.0)
Neutropenic infection 40 ( 17.9) 19 ( 8.6) 27 ( 12.1) 14 ( 6.3) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0)
Pancytopenia c d %
Febrile neutropenia c
Infections and
Pneumonias*
infestations #
c %
Bronchitis c
Nasopharyngitis
e
31 ( 13.8) 15 ( 6.8) 23 ( 10.3) 7 ( 3.2) 50 ( 17.1) 13 ( 4.6) 27 ( 9.2) 5 ( 1.8)
10 ( 4.5) 9 ( 4.1) 1 ( 0.4) 5 ( 2.3) 139 ( 47.4) 104 ( 37.1) 4 ( 1.4) 1 ( 0.4)
5 ( 2.2) 2 ( 0.9) 0 ( 0.0) 0 ( 0.0) 102 ( 34.8) 84 ( 30.0) 1 ( 0.3) 0 ( 0.0)
Gastroenteritis c 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) 66 ( 22.5) 55 ( 19.6) 6 ( 2.0) 0 ( 0.0)
Rhinitis e 2 ( 0.9) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) 44 ( 15.0) 19 ( 6.8) 0 ( 0.0) 0 ( 0.0)
e 8 ( 3.6) 3 ( 1.4) 0 ( 0.0) 0 ( 0.0) 41 ( 14.0) 26 ( 9.3) 0 ( 0.0) 1 ( 0.4)
Influenza c 8 ( 3.6) 5 ( 2.3) 2 ( 0.9) 1 ( 0.5) 39 ( 13.3) 19 ( 6.8) 3 ( 1.0) 0 ( 0.0)
Sinusitis
21 ( 9.4) 2 ( 0.9) 19 ( 8.5) 2 ( 0.9) 9 ( 3.1) 4 ( 1.4) 1 ( 0.3) 0 ( 0.0)
Lower respiratory tract
infection e 13 ( 5.8) 5 ( 2.3) 6 ( 2.7) 4 ( 1.8) 4 ( 1.4) 4 ( 1.4) 0 ( 0.0) 2 ( 0.7)
Infection c 12 ( 5.4) 6 ( 2.7) 9 ( 4.0) 5 ( 2.3) 17 ( 5.8) 5 ( 1.8) 0 ( 0.0) 0 ( 0.0)
Urinary tract infection
c d e
9 ( 4.0) 5 ( 2.3) 4 ( 1.8) 4 ( 1.8) 22 ( 7.5) 17 ( 6.1) 1 ( 0.3) 0 ( 0.0)
Lower respiratory tract
infection bacterial d 6 ( 2.7) 1 ( 0.5) 4 ( 1.8) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0)
Bacteremia d 5 ( 2.2) 0 ( 0.0) 4 ( 1.8) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0)
11 ( 4.9) 10 ( 4.5) 3 ( 1.3) 2 ( 0.9) 29 ( 9.9) 25 ( 8.9) 6 ( 2.0) 2 ( 0.7)
2 ( 0.9) 1 ( 0.5) 0 ( 0.0) 0 ( 0.0) 6 ( 2.0) 1 ( 0.4) 4 ( 1.4) 1 ( 0.4)
Herpes zoster
c d
Sepsis* c d @
Gastrointestinal disorders
Diarrhea 122 ( 54.5) 83 ( 37.6) 22 ( 9.8) 17 ( 7.7) 114 ( 38.9) 34 ( 12.1) 7 ( 2.4) 0 ( 0.0)
Nausea e 33 ( 14.7) 22 ( 10.0) 16 ( 7.1) 10 ( 4.5) 31 ( 10.6) 28 ( 10.0) 0 ( 0.0) 0 ( 0.0)
Vomiting 17 ( 7.6) 12 ( 5.4) 8 ( 3.6) 5 ( 2.3) 16 ( 5.5) 15 ( 5.4) 1 ( 0.3) 0 ( 0.0)
Constipation e 12 ( 5.4) 8 ( 3.6) 0 ( 0.0) 0 ( 0.0) 37 ( 12.6) 25 ( 8.9) 2 ( 0.7) 0 ( 0.0)
Abdominal pain e 8 ( 3.6) 7 ( 3.2) 1 ( 0.4) 4 ( 1.8) 31 ( 10.6) 15 ( 5.4) 1 ( 0.3) 1 ( 0.4)
Abdominal pain upper e 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) 20 ( 6.8) 12 ( 4.3) 1 ( 0.3) 0 ( 0.0)
General disorders and administration site conditions
Asthenia 0 ( 0.0) 1 ( 0.5) 0 ( 0.0) 0 ( 0.0) 87 ( 29.7) 53 ( 18.9) 10 ( 3.4) 2 ( 0.7)
Fatigue 51 ( 22.8) 30 ( 13.6) 21 ( 9.4) 9 ( 4.1) 31 ( 10.6) 15 ( 5.4) 3 ( 1.0) 0 ( 0.0)
Pyrexia e