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Adults with Chronic
Lymphocytic Leukemia/Small
Lymphocytic Lymphoma Adults with Waldenström's
Macroglobulinemia Previously Treated Chronic
Graft Versus Host Disease in
Adults and Children

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Understanding Chromosomal Changes in CLL/SLL Cells1

CLL/SLL cells can have chromosomal deletions (part of a chromosome lost or deleted), gene mutations (change), or a combination of both.

Chromosomal deletions1

  • Parts of a chromosome can be lost (deleted) during cell division. Chromosomal deletions are named “del” for “deletion” followed by the name of the missing piece.

Gene mutations1

  • Genes can become mutated (changed). Some mutations may cause cancer, but not all mutations are dangerous.

Gene mutations and chromosomal deletions can affect how CLL/SLL progresses and may help doctors develop your treatment plan.

How will my doctor know of chromosomal abnormalities in my CLL/SLL cells?1,2

One of the tests known to search for chromosomal deletions is FISH. FISH stands for “fluorescence in situ hybridization.” A different lab test, called DNA sequencing, examines CLL/SLL cells for gene mutations. It can identify the mutational status of IGHV (immunoglobulin heavy-chain variable region gene) and other genes.

What might my test results mean?1,3

Your test results may help you and your doctor better understand your disease. Up to 50% of patients with CLL/SLL have a sign of high-risk disease that can inform how their disease will progress. To learn more about genetic testing, contact your doctor.

Some genetic risk factors for CLL/SLL include:

Del 17p2,4,5

  • This chromosomal deletion indicates that CLL/SLL may be more aggressive compared to people with a complete chromosome.
  • Among people with CLL/SLL who have not had any treatment, about 3% to 10% have the 17p chromosome deletion. Del 17p can become more common as CLL progresses.

Del 11q2,3

  • Another chromosomal deletion that can mean that CLL/SLL may be more aggressive than in people with a complete chromosome.
  • About 1 in 5 people with CLL have 11q deletion.

Unmutated IGHV2,4,6

  • The unmutated immunoglobulin heavy-chain variable region (IGHV) gene is a risk factor linked to more aggressive disease.
  • Approximately 40% to 50% of people with CLL have unmutated IGHV.

 

References: 1. National Comprehensive Cancer Network. NCCN Guidelines for Patients®: Chronic lymphocytic leukemia. V1.2023. ©National Comprehensive Cancer Network, Inc. 2022. All rights reserved. 2. Leukemia and Lymphoma Society. The CLL Guide: Information for patients and caregivers. Chronic lymphocytic leukemia. Revised 2017. Accessed August 18, 2022. https://www.lls.org/sites/default/files/2021-07/PS34_CLL_Booklet_2021.pdf 3. Döhner H, Stilgenbauer S, James MR, et al. 11q deletions identify a new subset of B-cell chronic lymphocytic leukemia characterized by extensive nodal involvement and inferior prognosis. Blood. 1997;89(7):2516-2522. 4. Lee J, Wang Y.L. Prognostic and predictive molecular biomarkers in chronic lymphocytic leukemia. J Mol Diagn. 2020; 22 (9): 1114-1125. 5. Schnaiter A, Stilgenbauer S. 17p deletion in chronic lymphocytic leukemia: risk stratification and therapeutic approach. Hematol Oncol Clin North Am. 2013;27(2):289-301. 6. Kröber A, Seiler T, Benner A, et al. VH mutation status, CD38 expression level, genomic aberrations, and survival in chronic lymphocytic leukemia. Blood. 2002;100:1410-1416.

What Is CLL/SLL? IMBRUVICA® for CLL/SLL

IMPORTANT SIDE EFFECT INFORMATION

Before taking IMBRUVICA®, tell your healthcare provider about all of your medical conditions, including if you:

  • have had recent surgery or plan to have surgery. Your healthcare provider may stop IMBRUVICA® for any planned medical, surgical, or dental procedure.
  • have bleeding problems
  • have or had heart rhythm problems, smoke, or have a medical condition that increases your risk of heart disease, such as high blood pressure, high cholesterol, or diabetes
  • have an infection
  • have liver problems
  • are pregnant or plan to become pregnant. IMBRUVICA® can harm your unborn baby. If you are able to become pregnant, your healthcare provider will do a pregnancy test before starting treatment with IMBRUVICA®. Tell your healthcare provider if you are pregnant or think you may be pregnant during treatment with IMBRUVICA®. 
    • Females who are able to become pregnant should use effective birth control (contraception) during treatment with IMBRUVICA® and for 1 month after the last dose.
    • Males with female partners who are able to become pregnant should use effective birth control, such as condoms, during treatment with IMBRUVICA® and for 1 month after the last dose.
  • are breastfeeding or plan to breastfeed. Do not breastfeed during treatment with IMBRUVICA® and for 1 week after the last dose. 

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Taking IMBRUVICA® with certain other medicines may affect how IMBRUVICA® works and can cause side effects.

How should I take IMBRUVICA®?

  • Take IMBRUVICA® exactly as your healthcare provider tells you to take it.
  • Take IMBRUVICA® 1 time a day at about the same time each day.

    IMBRUVICA® comes as capsules, tablets, and oral suspension.

  • If your healthcare provider prescribes IMBRUVICA® capsules or tablets:
    • Swallow IMBRUVICA® capsules or tablets whole with a glass of water.
    • Do not open, break, or chew IMBRUVICA® capsules.
    • Do not cut, crush, or chew IMBRUVICA® tablets.
  • If your healthcare provider prescribes IMBRUVICA® oral suspension:
    • See the detailed Instructions for Use that comes with IMBRUVICA® oral suspension for information about the correct way to give a dose to your child. If you have questions about how to give IMBRUVICA® oral suspension, talk to your healthcare provider.
    • Do not use if the carton seal is broken or missing.
  • If you miss a dose of IMBRUVICA® take it as soon as you remember on the same day. Take your next dose of IMBRUVICA® at your regular time on the next day. Do not take extra doses of IMBRUVICA® to make up for a missed dose.
  • If you take too much IMBRUVICA® call your healthcare provider or go to the nearest hospital emergency room right away. 

What should I avoid while taking IMBRUVICA®?

  • You should not drink grapefruit juice, eat grapefruit, or eat Seville oranges (often used in marmalades) during treatment with IMBRUVICA®. These products may increase the amount of IMBRUVICA® in your blood.

What are the possible side effects of IMBRUVICA®?

IMBRUVICA® may cause serious side effects, including:

  • Bleeding problems (hemorrhage) are common during treatment with IMBRUVICA®, and can also be serious and may lead to death. Your risk of bleeding may increase if you are also taking a blood thinner medicine. Tell your healthcare provider if you have any signs of bleeding, including: blood in your stools or black stools (looks like tar), pink or brown urine, unexpected bleeding, or bleeding that is severe or that you cannot control, vomit blood or vomit looks like coffee grounds, cough up blood or blood clots, increased bruising, dizziness, weakness, confusion, change in your speech, or a headache that lasts a long time or severe headache.  
  • Infections can happen during treatment with IMBRUVICA®. These infections can be serious and may lead to death. Tell your healthcare provider right away if you have fever, chills, weakness, confusion, or other signs or symptoms of an infection during treatment with IMBRUVICA®.
  • Heart problems. Serious heart rhythm problems (ventricular arrhythmias, atrial fibrillation and atrial flutter), heart failure and death have happened in people treated with IMBRUVICA®, especially in people who have an infection, an increased risk for heart disease, or have had heart rhythm problems in the past. Your heart function will be checked before and during treatment with IMBRUVICA®. Tell your healthcare provider if you get any symptoms of heart problems, such as feeling as if your heart is beating fast and irregular, lightheadedness, dizziness, shortness of breath, swelling of the feet, ankles or legs, chest discomfort, or you faint. If you develop any of these symptoms, your healthcare provider may do tests to check your heart and may change your IMBRUVICA® dose.
  • High blood pressure (hypertension). New or worsening high blood pressure has happened in people treated with IMBRUVICA®. Your healthcare provider may start you on blood pressure medicine or change current medicines to treat your blood pressure.
  • Decrease in blood cell counts. Decreased blood counts (white blood cells, platelets, and red blood cells) are common with IMBRUVICA®, but can also be severe. Your healthcare provider should do monthly blood tests to check your blood counts.
  • Second primary cancers. New cancers have happened during treatment with IMBRUVICA®, including cancers of the skin or other organs.
  • Tumor lysis syndrome (TLS). TLS is caused by the fast breakdown of cancer cells. TLS can cause kidney failure and the need for dialysis treatment, abnormal heart rhythm, seizure, and sometimes death. Your healthcare provider may do blood tests to check you for TLS.

The most common side effects of IMBRUVICA® in adults with B-cell malignancies (CLL/SLL and WM) include:

  • diarrhea
  • tiredness
  • muscle and bone pain
  • rash
  • bruising

The most common side effects of IMBRUVICA® in adults or children 1 year of age and older with cGVHD include:

  • tiredness
  • low red blood cell count (anemia)
  • bruising
  • diarrhea
  • low platelet count
  • muscle and joint pain
  • fever
  • muscle spasms
  • mouth sores (stomatitis)
  • bleeding
  • nausea 
  • stomach pain 
  • pneumonia
  • headache

Diarrhea is a common side effect in people who take IMBRUVICA®. Drink plenty of fluids during treatment with IMBRUVICA® to help reduce your risk of losing too much fluid (dehydration) due to diarrhea. Tell your healthcare provider if you have diarrhea that does not go away.

These are not all the possible side effects of IMBRUVICA®. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

General information about the safe and effective use of IMBRUVICA®

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use IMBRUVICA® for a condition for which it was not prescribed. Do not give IMBRUVICA® to other people, even if they have the same symptoms that you have. It may harm them. You can ask your pharmacist or healthcare provider for information about IMBRUVICA® that is written for health professionals.

Please see the full Important Product Information.

USES

What is IMBRUVICA® (ibrutinib)?

IMBRUVICA® (ibrutinib) is a prescription medicine used to treat:

  • Adults with chronic lymphocytic leukemia (CLL)/Small lymphocytic lymphoma (SLL).
  • Adults with chronic lymphocytic leukemia (CLL)/Small lymphocytic lymphoma (SLL) with 17p deletion.
  • Adults with Waldenström's macroglobulinemia (WM).
  • Adults and children 1 year of age and older with chronic graft versus host disease (cGVHD) after failure of 1 or more lines of systemic therapy.

It is not known if IMBRUVICA® is safe and effective in children under 1 year of age.

IMPORTANT SIDE EFFECT INFORMATION

USES

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