Zanubrutinib-induced liver injury: a case report and literature review

Atallah, Edmond; Wijayasiri, Pramudi; Cianci, Nicole; Abdullah, Khorrum; Mukherjee, Abhik; Aithal, Guruprasad P.

Abstract

Background: Zanubrutinib is a Bruton’s tyrosine kinase inhibitor that has been recently licensed in refractory mantle cell lymphoma and under assessment in phase 3 clinical trials for other B cell malignancies. To date, there are no reported cases of hepatotoxicity secondary to zanubrutinib. We report the first case of severe liver injury due to zanubrutinib.
Case presentation: A 56-year-old Caucasian male with a history of relapsed lymphoplasmacytic lymphoma was admitted to the hospital with new-onset jaundice, choluria, and pruritus for 10 days. He had been on zanubrutinib as part of a clinical trial for 30 months. His blood profile showed a severe hepatocellular injury with jaundice (alanine transaminase 2474 IU/L and total bilirubin 141 umol/L with mild coagulopathy). He had an extensive work-up including virology, autoimmune, and metabolic profiles in addition to abdominal ultrasound with no alternative explanation found for his liver injury. Zanubrutinib-induced liver injury was suspected, and causality assessment by the updated Roussel Uclaf Causality Assessment Method score showed a probable causal relationship with zanubrutinib. His liver histology was also consistent with drug-induced liver injury. His liver biochemistry improved following cessation of zanubrutinib and normalised after 8 weeks.
Conclusion: We report the first case of severe liver injury secondary to zanubrutinib after 30 months of treatment. This case raises clinical awareness regarding zanubrutinib-induced liver toxicity and the importance of drug withdrawal in the event of liver injury.

Citation

Atallah, E., Wijayasiri, P., Cianci, N., Abdullah, K., Mukherjee, A., & Aithal, G. P. (2021). Zanubrutinib-induced liver injury: a case report and literature review. BMC Gastroenterology, 21(1), Article 244. https://doi.org/10.1186/s12876-021-01825-2

• Journal Article Type: Article
• Acceptance Date: May 23, 2021
• Online Publication Date: May 29, 2021
• Publication Date: Dec 1, 2021
• Deposit Date: Jun 11, 2021
• Publicly Available Date: Jun 21, 2021
• Journal: BMC Gastroenterology
• Electronic ISSN: 1471-230X
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 21
• Issue: 1
• Article Number: 244
• DOI: https://doi.org/10.1186/s12876-021-01825-2
• Keywords: Gastroenterology; General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/5655249
• Publisher URL: https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01825-2