Successful Treatment of Evans Syndrome Onset With Zanubrutinib in Combination With Romiplostim During Venetoclax Treatment in a Patient With Chronic Lymphocytic Leukemia: A Case Report.

Chronic lymphocytic leukemia (CLL) can be complicated by autoimmune cytopenias, including autoimmune hemolytic anemia and immune thrombocytopenia (ITP), as observed in Evans syndrome. We report the case of a 75-year-old man with CLL who developed steroid- and rituximab-refractory Evans syndrome during the ramp-up phase of venetoclax treatment. The patient presented worsening of preexisting subclinical hemolysis that had been present before starting venetoclax, along with severe ITP (platelets 0 × 109/L), unresponsive to standard therapies including steroids, immunoglobulins, and rituximab. Rescue treatment with the combination of romiplostim, a thrombopoietin receptor agonist, and zanubrutinib, a second-generation Bruton's tyrosine kinase inhibitor, led to complete and sustained platelet recovery within 4 weeks. This case highlights the potential of combining zanubrutinib with a thrombopoietin receptor agonist in managing severe ITP secondary to CLL, particularly when conventional therapies fail.