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Monitoring and Management of Toxicities of Novel B Cell Signaling Agents

  • Joanna Rhodes
  • Anthony Mato
  • Jeff P. Sharman
Lymphomas (MR Smith, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Lymphomas

Abstract

Purpose review

B cell signaling agents, including ibrutinib, idelalisib, and the BCL-2 inhibitor venetoclax have become an integral part of therapy for patients with non-Hodgkin’s lymphomas. The toxicity profiles of these medications is distinct from chemoimmunotherapy. Here, we will review the mechanism of action of these drugs, their efficacy, and toxicity management.

Recent findings

Ibrutinib use is associated with increased risk of atrial fibrillation and bleeding which can be managed using dose interruptions and modifications. Patients on idelalisib require close clinical and frequent laboratory monitoring, particularly of liver function tests to ensure there are no serious adverse events. Monitoring for infections is important in patients on both idelalisib and ibrutinib. Venetoclax requires close clinical and laboratory monitoring to prevent significant tumor lysis.

Summary

Targeted B cell receptor therapies each have unique side effect profiles which require careful clinical monitoring. As we continue to use these therapies, optimal management strategies will continue to be elucidated.

Keywords

Toxicity Ibrutinib Idelalisib Venetoclax Colitis Pneumonitis Opportunistic infections Tumor lysis Atrial fibrillation Receptor signaling 

Notes

Compliance with Ethical Standards

Conflict of Interest

Joanna Rhodes declares that she has no conflict of interest.

Anthony Mato has received research funding from Portola, AbbVie, Acerta, DTRM, TG Therapeutics, Pharmacyclics, and Regeneron; has received compensation from AbbVie, AstraZeneca, Janssen, and Kite for service as a consultant; and has served on advisory boards for Gilead, TG Therapeutics, and Celgene.

Jeff P. Sharman has received research funding from AbbVie, Gilead, Acerta, TG Therapeutics, and Pharmacyclics; has received compensation from AbbVie, Gilead, Acerta, TG Therapeutics, and Pharmacyclics for service as a consultant; and has served on an advisory board for Genentech.

Human and Animal Rights and Informed Consent

This article contains studies with human or animal subjects performed by the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of PennsylvaniaPhiladelphiaUSA
  2. 2.Memorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Williamette Valley Cancer Institute and Research CenterEugeneUSA

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