The role of Bruton's kinase inhibitors (BTKi) in accelerated Chronic Lymphocytic Leukemia (a-CLL): a case of successful response to acalabrutinib.

OBJECTIVES: The use of Bruton's tyrosine kinase (BTK) inhibitors has changed the clinical history of patients with chronic lymphocytic leukemia (CLL) in both naïve and relapsed/refractory settings. "Accelerated" chronic lymphocytic leukemia (a-CLL) is a relatively rare form of CLL representing less than 1 % of all CLL cases. a-CLL patients usually have a more aggressive course and a reduced overall survival was reported with conventional chemo-immunotherapy approaches. METHODS: The role of Bruton Tyrosine Kinase-inhibitor, ibrutinib, in a-CLL is well established with encouraging preliminary results. RESULTS: We report a case of a-CLL-treated first-line with second-generation BTKi, acalabrutinib with a prompt clinical response. As known, it is the first literature report on acalabrutinib in a-CLL highlighting the role of second-generation BTKi also in this high-risk setting. CONCLUSIONS: Target therapies (Bruton Kinase inhibitors and Bcl2 inhibitors) have improved the therapeutic landscape of CLL. The availability of therapeutic targets requires greater diagnostic accuracy to choose the most appropriate therapy for each patient.

Changing Trends in B-Cell Non-Hodgkin Lymphoma Treatment: The Role of Novel Monoclonal Antibodies in Clinical Practice.

We are currently witnessing a dramatic shift in our approach to the treatment of B-cell non-Hodgkin lymphoma (B-NHL). In the evolving clinical landscape, novel treatments for this clinically heterogeneous disease span a wide range of interventions, encompassing targeted agents, cell therapy approaches, and novel monoclonal antibodies (NMABs). Among these, the latter are likely to exert the most profound impact due to their distinctive high efficacy and versatile applicability. NMABs represent a heterogeneous group of agents, including naked antibodies, immunotoxins, and T-cell-engaging molecules. In recent times, several NMABs have either gained regulatory approval or are on the verge of introduction into clinical practice, addressing multiple therapeutic indications and treatment regimens. Their anticipated impact is expected to be broad, initially in the context of relapsed/refractory (R/R) disease and subsequently extending to early treatment lines. The scope of this review is to provide a comprehensive overview of the biological characteristics, clinical properties, efficacy, and toxicity profiles of NMABs that have recently been introduced or are nearing integration into clinical practice.

Tratamento de gestantes com epilepsia: papel dos medicamentos antiepilépticos clássicos e novos: [revisão] / Treating women with epilepsy during pregnancy: the role of traditional and new antiepileptic drugs: [review]

As epilepsias constituem a doença neurológica crônica grave mais comum e têm implicações terapêuticas relacionadas ao sexo. As informações sobre os riscos do uso das drogas antiepilépticas clássicas e novas durante a gestação são muito importantes tanto para a saúde da mulher quanto para a do feto. OBJETIVO: Realizar uma revisão da literatura referente aos aspectos terapêuticos das gestantes com epilepsia. MÉTODO: Revisão da literatura com o uso das palavras chave: epilepsia/crises/convulsões e gestação, drogas antiepilépticas, farmacocinética, teratogênese, malformações e uso de folato/ácido fólico. DISCUSSÃO E CONCLUSÃO: As metodologias utilizadas são muito variáveis além de ocorrerem complicações decorrentes do uso das novas drogas. A contribuição do uso das DAE novas e tradicionais, sua farmacocinética e a ocorrência de epilepsia/crises na gestação podem prejudicar a evolução da gravidez e não têm sido claramente delineadas. Os autores enfatizam a necessidade de estudos para avaliar o impacto da epilepsia e seu tratamento na vida reprodutiva, a fim de otimizar seu tratamento, além da necessidade de estudos farmacocinéticos durante a gestação para obtenção de melhores resultados terapêuticos e também para a diminuição dos efeitos nocivos das drogas sobre a mãe e o feto.

Epilepsy is a common neurological condition with gender-related management implications. The potential risk of using antiepileptic drugs (AEDs) is a major concern for women with epilepsy who are considering pregnancy. Traditional AEDs are associated with an at least twofold risk of fetal malformation compared with the general population. The risks with the newer AEDs are still unclear and there is an urgent need for further kinetic data from pregnancy. OBJECTIVE: A review of literature referable to management issues for women with epilepsy (WWE) was undertaken for the discussion of treatment approach. METHODS: A literature search was conducted using the following key words/phrases: epilepsy/seizures and pregnancy, antiepileptic drugs, pharmacokinetics, teratogenesis, birth defects, malformations, and use of folate/folic acid. DISCUSSION: Pregnancy outcome literature for WWE spans several decades. Methodology varies and interpretation is complicated by modern management strategies. Contributions of the use of antiepileptic drugs, their pharmacokinetics, occurrence of maternal epilepsy, and seizures during pregnancy to adverse pregnancy outcomes have not been clearly delineated. CONCLUSIONS: WWE face health issues for which there are no available outcome literature to guide decision-making.