Evidence map›Paper›PMID 42192981›Full record

ReviewCancers2026

The Immunologic Paradox of BTK Inhibitors in Chronic Lymphocytic Leukemia: Selectivity, Hypogammaglobulinemia, and Infection Risk.

Mihaela Andreescu, Sorin Ioan Tudorache, Cosmin Alec Moldovan, Adina-Diana Moldovan, Daniel Cochior, Viola Popov, Bogdan Andreescu, Diana Ionescu, Monica-Daniela Padurariu-Covit

Abstract readReview
In one paragraph

Review in Cancers, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Mihaela AndreescuDepartment of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, 031593 Bucharest, Romania.ORCID 0000-0003-0532-7929
Sorin Ioan TudoracheDepartment of Preclinical Disciplines, Faculty of Medicine, Titu Maiorescu University, 031593 Bucharest, Romania.
Cosmin Alec MoldovanDepartment of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, 031593 Bucharest, Romania.ORCID 0000-0003-1362-6427
Adina-Diana MoldovanDepartment of Preclinical Disciplines, Faculty of Medicine, Titu Maiorescu University, 031593 Bucharest, Romania.ORCID 0009-0000-5781-1953
Daniel CochiorDepartment of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, 031593 Bucharest, Romania.
Viola PopovDepartment of Hematology, Colentina Clinical Hospital, 020125 Bucharest, Romania.ORCID 0000-0002-1200-379X
Bogdan AndreescuDepartment of Plastic Surgery, Colentina Clinical Hospital, 020125 Bucharest, Romania.
Diana IonescuDepartment of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, 031593 Bucharest, Romania.
Monica-Daniela Padurariu-CovitResearch Centre in the Medical-Pharmaceutical Field, Faculty of Medicine and Pharmacy Dunarea de Jos University, 800008 Galati, Romania.ORCID 0000-0002-4237-2297

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Bruton's tyrosine kinase (BTK) inhibitors have revolutionized B-cell malignancy treatment but paradoxically increase infection susceptibility. Covalent BTK inhibitors (Ibrutinib, Acalabrutinib, Zanubrutinib) induce sustained BTK blockade but disrupt immune homeostasis through off-target effects on T-cell and myeloid signaling, contributing to hypogammaglobulinemia and increased risk of bacterial, viral, and opportunistic fungal infections. Non-covalent inhibitors (Pirtobrutinib) and emerging BTK degraders offer more selective inhibition, preserving T-cell function and potentially mitigating infection risk, though their long-term immunological impact requires further study. Infection susceptibility varies across BTK inhibitor generations, reflecting differences in kinase selectivity, modulation of humoral and cellular immunity, and disease-intrinsic immune dysfunction in chronic lymphocytic leukemia. This review examines the mechanistic basis of BTK inhibitor-associated immune dysfunction, compares generational differences in selectivity and safety profiles, and provides evidence-based recommendations for infection risk mitigation in clinical practice.

Indexed as

AcalabrutinibB-cell malignanciesBTK inhibitorschronic lymphocytic leukemiahypogammaglobulinemiaIbrutinibimmunomodulationinfection riskPirtobrutinibT-cell immunity

Identifiers

PMID42192981
PMCPMC13204235

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.