{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T02:38:38Z","timestamp":1790735918744,"version":"4.1.0"},"reference-count":29,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hematology Reports"],"abstract":"<jats:p>Background: Ibrutinib, a Bruton\u2019s tyrosine kinase inhibitor (BTKi), has revolutionized the treatment of Chronic Lymphocytic Leukemia (CLL), yet hepatotoxicity remains a rare and poorly characterized adverse event. Case Presentation: We report the case of a 54-year-old man with progressive CLL and radiologically confirmed hepatic involvement who developed acute hepatocellular injury during ibrutinib monotherapy. Baseline liver tests showed mild abnormalities attributed to hepatic steatosis and leukemic infiltration. After approximately 10\u201312 weeks of ibrutinib (420 mg\/day), transaminases markedly increased (ALT 660 U\/L, AST 326 U\/L), while bilirubin and synthetic function remained normal. Viral, autoimmune, and obstructive causes were excluded. Stepwise dose reductions to 140 mg\/day provided limited benefit. The addition of prednisone (50 mg\/day) led to rapid biochemical improvement. Ibrutinib was successfully re-escalated to 280 mg\/day alongside venetoclax initiation, maintaining disease control without recurrence of liver injury. Discussion: The temporal relationship, exclusion of alternative causes, and corticosteroid responsiveness suggest an ibrutinib-induced liver injury, possibly exacerbated by pre-existing hepatic steatosis and leukemic infiltration. Conclusions: This case underscores the multifactorial pathogenesis of BTKi-related hepatotoxicity and highlights the potential role of corticosteroids in management. Prompt recognition, stepwise dose adjustment, and corticosteroid therapy may enable continued treatment and sustained disease control in selected patients.<\/jats:p>","DOI":"10.3390\/hematolrep17060069","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T14:30:17Z","timestamp":1765463417000},"page":"69","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Ibrutinib-Associated Liver Injury in a Patient with Chronic Lymphocytic Leukemia: Clinical Course and Therapeutic Approach"],"prefix":"10.3390","volume":"17","author":[{"given":"Antonio","family":"Frolli","sequence":"first","affiliation":[{"name":"Department of Clinical and Biological Sciences, University of Turin, 10124 Turin, Italy"},{"name":"Division of Hematology, AO Ordine Mauriziano di Torino, 10128 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Parvis","sequence":"additional","affiliation":[{"name":"Division of Hematology, AO Ordine Mauriziano di Torino, 10128 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Bullo","sequence":"additional","affiliation":[{"name":"Division of Hematology, AO Ordine Mauriziano di Torino, 10128 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selene","family":"Grano","sequence":"additional","affiliation":[{"name":"Division of Hematology, AO Ordine Mauriziano di Torino, 10128 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Fornari","sequence":"additional","affiliation":[{"name":"Division of Hematology, AO Ordine Mauriziano di Torino, 10128 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6491-8337","authenticated-orcid":false,"given":"Valentina","family":"Bonuomo","sequence":"additional","affiliation":[{"name":"Division of Hematology, AO Ordine Mauriziano di Torino, 10128 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6346-4791","authenticated-orcid":false,"given":"Daniela","family":"Cilloni","sequence":"additional","affiliation":[{"name":"Department of Clinical and Biological Sciences, University of Turin, 10124 Turin, Italy"},{"name":"Division of Hematology, AO Ordine Mauriziano di Torino, 10128 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4896-981X","authenticated-orcid":false,"given":"Carmen","family":"Fava","sequence":"additional","affiliation":[{"name":"Department of Clinical and Biological Sciences, University of Turin, 10124 Turin, Italy"},{"name":"Division of Hematology, AO Ordine Mauriziano di Torino, 10128 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.1002\/ajh.26367","article-title":"Chronic lymphocytic leukemia: 2022 update on diagnostic and therapeutic procedures","volume":"96","author":"Hallek","year":"2021","journal-title":"Am. J. Hematol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s11899-024-00726-x","article-title":"Frontline Therapy of CLL-Changing Treatment Paradigms","volume":"19","author":"Coombs","year":"2024","journal-title":"Curr. Hematol. Malig. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3286","DOI":"10.1182\/blood-2014-02-548610","article-title":"Ibrutinib inhibits BCR and NF-\u03baB signaling and reduces tumor proliferation in tissue-resident cells of patients with CLL","volume":"123","author":"Herman","year":"2014","journal-title":"Blood"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.3324\/haematol.2018.192328","article-title":"Sustained efficacy and detailed clinical follow-up of first-line ibrutinib treatment in older patients with chronic lymphocytic leukemia: Extended phase 3 results from RESONATE-2","volume":"103","author":"Barr","year":"2018","journal-title":"Haematologica"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/S1470-2045(23)00144-4","article-title":"Ibrutinib and rituximab versus fludarabine, cyclophosphamide, and rituximab for patients with previously untreated chronic lymphocytic leukaemia (FLAIR): Interim analysis of a multicentre, open-label, randomised, phase 3 trial","volume":"24","author":"Hillmen","year":"2023","journal-title":"Lancet Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1111\/bjh.17984","article-title":"Long-term efficacy of first-line ibrutinib treatment for chronic lymphocytic leukaemia in patients with TP53 aberrations: A\u2009pooled analysis from four clinical trials","volume":"196","author":"Allan","year":"2022","journal-title":"Br. J. Haematol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1001\/jamaoncol.2021.1649","article-title":"Ibrutinib Plus Venetoclax for First-line Treatment of Chronic Lymphocytic Leukemia: A Nonrandomized Phase 2 Trial","volume":"7","author":"Jain","year":"2021","journal-title":"JAMA Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3278","DOI":"10.1182\/blood.2021014488","article-title":"Fixed-duration ibrutinib plus venetoclax for first-line treatment of CLL: Primary analysis of the CAPTIVATE FD cohort","volume":"139","author":"Tam","year":"2022","journal-title":"Blood"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.medcli.2024.10.018","article-title":"Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia and small lymphocytic lymphoma from Chronic Lymphocytic Leukemia Spanish Group (GELLC). Gu\u00eda para el diagn\u00f3stico y el tratamiento de la leucemia linfoc\u00edtica cr\u00f3nica y el linfoma linfoc\u00edtico de c\u00e9lulas peque\u00f1as del Grupo Espa\u00f1ol de Leucemia Linfoc\u00edtica Cr\u00f3nica (GELLC)","volume":"164","author":"Medina","year":"2025","journal-title":"Med. Clin."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"874","DOI":"10.3324\/haematol.2017.182907","article-title":"Toxicities and outcomes of 616 ibrutinib-treated patients in the United States: A real-world analysis","volume":"103","author":"Mato","year":"2018","journal-title":"Haematologica"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1002\/ccr3.881","article-title":"Ibrutinib-induced severe liver injury","volume":"5","author":"Nandikolla","year":"2017","journal-title":"Clin. Case Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1080\/10428194.2017.1346251","article-title":"Ibrutinib-induced acute liver failure","volume":"59","author":"Kahn","year":"2018","journal-title":"Leuk. Lymphoma"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e307","DOI":"10.1097\/HS9.0000000000000307","article-title":"Rare but Serious: Ibrutinib Induced Liver Failure","volume":"3","author":"Kleijwegt","year":"2019","journal-title":"Hemasphere"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1159\/000502605","article-title":"Severe Hepatotoxicity due to Ibrutinib with a Review of Published Cases","volume":"13","author":"Tafesh","year":"2019","journal-title":"Case Rep. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"P\u00e9rez-G\u00f3mez, N., Sanz-Solas, A., Cuevas, B., Cuevas, M.V., Alonso-Madrigal, C., Loscertales, J., \u00c1lvarez-Nu\u00f1o, R., Garc\u00eda, C., Zubiaur, P., and Villapalos-Garc\u00eda, G. (2025). Pharmacogenetic Biomarkers of Ibrutinib Response and Toxicity in Chronic Lymphocytic Leukemia: Insights from an Observational Study. Pharmaceuticals, 18.","DOI":"10.3390\/ph18070996"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Vigan\u00f2, M., La Milia, M., Grassini, M.V., Pugliese, N., De Giorgio, M., and Fagiuoli, S. (2023). Hepatotoxicity of Small Molecule Protein Kinase Inhibitors for Cancer. Cancers, 15.","DOI":"10.3390\/cancers15061766"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Gerussi, A., Natalini, A., Antonangeli, F., Mancuso, C., Agostinetto, E., Barisani, D., Di Rosa, F., Andrade, R., and Invernizzi, P. (2021). Immune-Mediated Drug-Induced Liver Injury: Immunogenetics and Experimental Models. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22094557"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Liu, Y., Song, Y., and Yin, Q. (2022). Effects of ibrutinib on T-cell immunity in patients with chronic lymphocytic leukemia. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.962552"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Bj\u00f6rnsson, E.S., Vucic, V., Stirnimann, G., and Robles-D\u00edaz, M. (2022). Role of Corticosteroids in Drug-Induced Liver Injury. A Systematic Review. Front. Pharmacol., 13.","DOI":"10.3389\/fphar.2022.820724"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1080\/15384047.2021.1980313","article-title":"Ibrutinib\u2019s off-target mechanism: Cause for dose optimization","volume":"22","author":"Zimmerman","year":"2021","journal-title":"Cancer Biol. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1111\/sji.12333","article-title":"Targets for Ibrutinib Beyond B Cell Malignancies","volume":"82","author":"Hamasy","year":"2015","journal-title":"Scand. J. Immunol."},{"key":"ref_22","first-page":"212","article-title":"Role of nonalcoholic fatty liver disease as risk factor for drug-induced hepatotoxicity","volume":"3","author":"Massart","year":"2017","journal-title":"J. Clin. Transl. Res."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Danan, G., and Teschke, R. (2015). RUCAM in Drug and Herb Induced Liver Injury: The Update. Int. J. Mol. Sci., 17.","DOI":"10.3390\/ijms17010014"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"155","DOI":"10.12701\/yujm.2019.00115","article-title":"Imatinib-induced hepatitis treated by corticosteroids in a patient with metastatic gastrointestinal stromal tumor","volume":"36","author":"Kang","year":"2019","journal-title":"Yeungnam Univ. J. Med."},{"key":"ref_25","first-page":"ECR27","article-title":"Corticosteroids can reverse severe imatinib-induced hepatotoxicity","volume":"91","author":"Ferrero","year":"2006","journal-title":"Haematologica"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1038\/s41408-023-00902-x","article-title":"Zanubrutinib: Past, present, and future","volume":"13","author":"Tam","year":"2023","journal-title":"Blood Cancer J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1182\/blood.2022018818","article-title":"Detailed safety profile of acalabrutinib vs ibrutinib in previously treated chronic lymphocytic leukemia in the ELEVATE-RR trial","volume":"142","author":"Seymour","year":"2023","journal-title":"Blood"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Atallah, E., Wijayasiri, P., Cianci, N., Abdullah, K., Mukherjee, A., and Aithal, G.P. (2021). Zanubrutinib-induced liver injury: A case report and literature review. BMC Gastroenterol., 21.","DOI":"10.1186\/s12876-021-01825-2"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1016\/S0140-6736(21)00224-5","article-title":"Pirtobrutinib in relapsed or refractory B-cell malignancies (BRUIN): A phase 1\/2 study","volume":"397","author":"Mato","year":"2021","journal-title":"Lancet"}],"container-title":["Hematology Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2038-8330\/17\/6\/69\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T15:54:58Z","timestamp":1765468498000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2038-8330\/17\/6\/69"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,11]]},"references-count":29,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["hematolrep17060069"],"URL":"https:\/\/doi.org\/10.3390\/hematolrep17060069","relation":{},"ISSN":["2038-8330"],"issn-type":[{"value":"2038-8330","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,11]]}}}