How do you manage bruising in patients on ibrutinib?  

Bruising is quite common in patients treated with ibrutinib, and it seems to be a class effect that also is seen with the 2nd generation BTK inhibitors, such as acalabrutinib. It should be mentioned when consenting patients, and reassurance generally is all that is needed because the bruising is usu...

Switch to acala.

For reference, a pooled analysis of 370 patients with relapsed/refractory MCL (Rule et al., PMID 28832957) treated on 3 different clinical trials with single agent ibrutinib showed a rate of contusion between 12-13%, all grade 1-2. Major hemorrhage was reported in 4.9% of patients with longer term f...

There is no easy answer. If the patient is very symptomatic, then options include pivoting to another BTKi or lowering the dose. If MCL, PCNSL, or more aggressive features where there is concern that lower dose may compromise efficacy, I am more likely to switch. Both acalabrutinib and zanubrutinib ...

I make sure they are not on "prophylactic" aspirin which is still pervasive but no longer considered necessary. 

Bruising is very common with ibrutinib and the newer generation covalent BTKIs. I always counsel patients on the risk of contusion and other bleeding events prior to starting. If a patient is on aspirin, I only recommend to continue it if there is a solid medical indication, since this may also affe...

Generally, no specific intervention is needed as most bruising is mild. If the disease is well controlled and bruising is a significant concern, I consider reducing the ibrutinib dose.