Ibrutinib-induced chronic demyelinating polyneuropathy in a 65-year-old man with chronic lymphoid leucosis: a clinical case

Abstract

Relevance. Most of oncological patients undergo chemotherapy, which has a wide range of various toxic reactions including polyneuropathy. Ibrutinib is a relatively new medicine with a few side effects associated with peripheral polyneuropathy. Demyelinating polyneuropathy induced by this drug is not yet defined in scientific literature. Methods. The paper describes the first case of demyelinating polyneuropathy associated with ibrutinib in a 65-yearold man with chronic lymphoid leucosis. The authors carried out clinical assessment, laboratory and instrumental examinations. Results. Ibrutinib administration was followed by chronic sensorimotor distal polyneuropathy. The changes measured in nerve conduction studies (NCS) corresponded to chronic inflammatory demyelinating polyneuropathy (CIDP) electrophysiological criteria (EFNS/PNS, 2010). The positive aspect of the described clinical case is that polyneuropathy regressed almost completely after a dose reduction and subsequent drug discontinuation. The second NCS made 5 months after a dose reduction showed an increase in compound motor action potential (CMAP) and nerve conduction velocities (NCV); however, normal values were not reached. Conclusion. This report on demyelinating neuropathy associated with ibrutinib requires further study of the drug effects. The below clinical description is of great interest since most of polyneuropathies associated with chemotherapy are axonal, but not demyelinating.

Keywords

• lymphoproliferative diseases
• chemotherapy
• chemotherapy-induced neuropathy
• ibrutinib
• chronic demyelinating polyneuropathy
• ncv
• spontaneous regress