Arcaro Teresa Rigacci Luigi
Chronic Lymphocytic Leukemia (CLL) is the most prevalent leukemia in adults in western countries. Remarkable strides have been achieved in treatment of CLL. One notable class of agents revolutionizing CLL treatment is Bruton’s Tyrosine Kinase inhibitors (BTKi), which have reshaped the landscape by proving viable alternatives to traditional chemotherapy and immunotherapy. The BTKi are indicated both in relapsed/refractory and at first line setting patients. The first-in-class BTKi, Ibrutinib, is generally administered until disease progression or until unacceptable toxicity. Despite Ibrutinib is considered easy manageable and well tolerated drug, instances of discontinuation are not uncommon. The most frequent reason leading to Ibrutinib discontinuation are infections. Drug discontinuation could determine a quick arise in lymphocyte count and their migration in lymphoid organs, leading to a rapid progression of the disease, in terms of reappearing of general symptoms, rapidly worsening of lymphadenopathy ore splenomegaly. In real life settings it has been documented a rapid drop of lymphocyte count attributable to the migration of lymphocyte to the spleen. which could represent a potential cause for splenic infarction and rupture. We reported the case report of a patient who discontinued Ibrutinib due to pulmonary infection. Subsequently, the patient experienced a life-threatening episode of splenic rupture, underscoring the critical considerations surrounding the discontinuation of such targeted therapies in the management of CLL.