Oral Inhibitors Safe for CLL Patients With Severe Renal Dysfunction

Oral targeted inhibitors are a viable treatment for patients with chronic lymphocytic leukemia (CLL) and severe renal dysfunction, according to a study presented at the Society of Hematologic Oncology 2024 Annual Meeting. However, treatment for CLL is unlikely to improve kidney function.

Researchers utilized data from the Veterans Affairs Corporate Data Warehouse, identifying 127 CLL patients with chronic renal impairment (defined as estimated glomerular filtration rate <30 ml/min/1.73 m²) who received oral targeted agents between 2013 and 2022. The study assessed the oral targeted inhibitors ibrutinib, acalabrutinib, zanubrutinib, venetoclax, and idelalisib. The researchers used statistical tools such as Fisher’s exact test, logistic regression, and Cox regression to analyze the data.

The median follow-up period was 24 months. Most patients were male (98%), with a median age of 75 years. Seventy percent of the patients began treatment at doses recommended by the US Food and Drug Administration. Dose reductions due to toxicity were commonly reported, especially with ibrutinib.

“Key findings indicate that renal dysfunction did not significantly improve with treatment, and dose adjustments did not impact treatment efficacy or survival rates,” the researchers wrote.

Researchers also identified that certain comorbidities, such as heart failure and cirrhosis, were significant factors that impacted overall survival.

Despite these findings, the results suggest that oral targeted inhibitors are a viable treatment option for CLL patients with severe renal dysfunction. However, careful monitoring of laboratory values and potential dose adjustments are necessary to ensure tolerability.

Reference

Anderson C, Lin C, Scobie MR, et al. Tolerability and outcomes of oral targeted inhibitors for chronic lymphocytic leukemia in patients with severe renal dysfunction. Abstract #CLL-027. Presented at the Society of Hematologic Oncology 2024 Annual Meeting; September 4-7, 2024; Houston, Texas.