Deferasirax and Ibrutinib

[ava1967ir]

Hi, my ferritin is 900, which is due to repeated blood transfusions , The oncologist has prescribed me Deferasirax 180 mg per day. On the other hand, my ibrutinib is 140 mg due to the take of voriconazole.

Is it necessary to change the dose of ibrutinib to take Deferasirax?

[AussieNeil Administrator]

Per drugs.com/interactions-chec...

"Using deferasirox together with ibrutinib may increase the risk of gastrointestinal ulcers and bleeding. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you experience potential signs and symptoms of gastrointestinal injury such as abdominal pain, bloating, dizziness, lightheadedness, loss of appetite, nausea, vomiting (especially with fresh or dried blood that looks like coffee grounds), and red or black, tarry stools. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor."

[ava1967ir in reply to AussieNeil]

Hi Neil and thanks for your reply, I checked that ibrutinib has a strong interaction with Deferasirax , Apparently, it increases the plasma levels of ibrutinib, probably for this reason, my oncologist prescribed Deferasirax with a low dose.

Unfortunately, after about 45 days of taking ibrutinib, I got frequent infections and was hospitalized three times. In addition to sepsis, I got lung aspergillus, and in addition to antifungal injections in the hospital, I have been taking voriconazole for more than 6 months. As you know, voriconazole has severe side effects. There is a drug interaction with ibrutinib, therefore the dose of ibrutinib has been reduced to 140 mg per day

In addition to voriconazole,due to neutropenia I have also taken Bactrim, Valacyclovir, and I have a monthly injection of 10 grams of IVIG, which was positive for me.

The positive result of my treatment is the reduction of the size of the spleen from 35 cm to 16 and the reduction of WBC from 165 k to about 10 k.

But unfortunately, due to severe anemia (Hb less than 7) and thrombocytopenia (PLT less than 10 K), I have to inject platelets and hemoglobin 3 times a month the result of which is an increase in ferritin and the prescription of deferasirox.

In my country, Iran, currently the only treatment available is ibrutinib and rituximab, and the infectious disease doctor will not allow rituximab treatment until my lungs are cleared of Aspergillus.I was supposed to do a bone marrow biopsy before starting treatment with rituximab, but according to the latest lung CT scan, I have to continue with voriconazole.

It is not clear if the cause of my cytopenia is the ibrutinib or the voriconazole or both, however I have to continue the voriconazole...

I am very confused and disappointed

Sorry, my English is not good

thanks & Regards

[AussieNeil Administrator in reply to ava1967ir]

Sorry to hear how difficult your experiences have been. I've heard how challenging antifungals can be. I hope you are soon able to stop taking voriconazole and that your blood counts quickly improve.

Absolutely no need to apologise for your English. Your reply was very easy to understand.

Neil

[ava1967ir in reply to AussieNeil]

Hi Neil,In the continuation of my treatment... It has been about 45 days since voriconazole has been stopped, ibrutinib has been changed to 280, but there has been no change in my condition, as before, I need platelet and hemoglobin injections due to cytopenia, and monthly IVIG continues I did BMB and BMA flow cytometry to evaluate the treatment.

FINAL DIAGNOSIS: Flow cytometry immunophenotyping result of BMA: Hypocellular BMA specimen,

Bone marrow involvement by a CD5- & CD10-, mature B cell lymphoproliferative disorder,

Flow cytometry immunophenotyping scoring: Score 0, not suggestive of B-CLL

—————————-

‏BMB sections show marrow spaces with 70% cellularity contains nodular small lymphocytic infiltration in interstitial & paratrabecular location

DIAGNOSIS : BMA & trephine needle biopsy: -Atypical nodular small lymphocytic infiltration compatible with small lymphocytic lymphoma Note: IHC for CD3, CD20, CD5, cyclin D1, Ki67 is mandatory,

————————-

The results of the reports have confused me:

As far as I understand: flow cytometry rejected CLL and diagnosed LPD…

On the other hand, the BMB diagnosis of SLL

I have an appointment with my oncologist next week

The reason why I don't ask my question publicly on the site is that different opinions make me more confused and anxious.

please give me your opinion.

Thanks & Regards

[AussieNeil Administrator in reply to ava1967ir]

Good to hear from you that your condition is stable and that you have been able to stop the antifungal.

Jm954 is far better able to give an opinion than me, but what does your doctor say?

Neil

[ava1967ir in reply to AussieNeil]

The latest lung CT shows a small amount of Aspergillus, the infectious disease doctor has stopped the drug due to the long-term use of voriconazole and its side effects.

Thanks your reply ،I asked Jm954 about my situation and I will inform you.🌺