Clinical significance of the immunomodulatory effect of Bruton’s tyrosine kinase inhibitors

The introduction of Bruton’s tyrosine kinase inhibitors (BTKis) into the treatment of chronic lymphocytic leukemia (CLL) has not only enabled disease remission but also contributed to immune system normalization.

Objective: To assess the clinical significance of the immunomodulatory effect of BTKis in patients with CLL during the COVID-19 pandemic.

Material and Methods. A retrospective study was conducted analyzing outpatient records and medical histories of CLL patients who developed pneumonia associated with COVID-19 infection. Group 1 included 35 patients receiving immunochemotherapy. Group 2 consisted of 17 patients receiving monotherapy with ibrutinib at a dose of 420 mg/day.

Results. Both groups showed a high incidence of pneumonia associated with COVID-19 and severe progression of pulmonary inflammatory processes. However, none of the patients receiving ibrutinib required mechanical ventilation, whereas 18 patients in the immunochemotherapy group did. Mortality in Group 1 was 42.8%. In the ibrutinib-treated group, no fatal outcomes occurred either due to superimposed pneumonia or progression of hematologic malignancy.

Conclusion. BTKi therapy is the most effective and safest option for CLL patients during the COVID-19 pandemic. This advantage is attributed to the immunomodulatory properties of BTKis, higher probability of achieving complete response compared to regimens involving monoclonal antibodies, and the feasibility of outpatient administration, thereby minimizing exposure to healthcare settings where viral infections may be present.

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