Ibrutinib is Bruton’s tyrosine kinase inhibitor that now become the standard of care for the treatment of CLL (chronic lymphocytic leukemia) and other lymphoid cancers. With its increasing usage, oncologists must become more aware of their potential side effect profile. Ibrutinib is typically thought to be less immunosuppressive than standard immunotherapy; however, can still cause devastating side effects. We present a case of CNS-invasive aspergillosis in a patient with Waldenstrom’s macroglobulinemia being managed with ibrutinib. We hypothesize that treatment with ibrutinib can resemble those with X-gammaglobulinemia, thus putting our patient at risk of developing such an invasive fungal infection. Traditional risk factors for CNS-invasive aspergillosis include neutropenia, systemic glucocorticoid treatment, mastoidectomy, spinal anesthesia and paraspinal glucocorticoid injections. Oncologists need to weigh the risks and benefits of ibrutinib therapy in certain populations and more data in the future may suggest potentially adding empiric antifungal coverage with its usage.

As is known, the superficial charge of most somatic cells is negative. Proceeding from this fact, somatic cells never interact. There is always some type of space (intercellular space) between them. Intercellular contacts are predominantly determined by two main factors: Van der Waals (positive taxis) and electrostatic (negative taxis) forces contributing to the formation of membrane electric potential. Presence of the intercellular space is a structural representation of the balance bet­ween these forces (contact inhibition).

Denosumab is a relatively new medicine that has become the second option in the treatment of biphosphonate-resistant or intolerant osteoporosis. Subcutaneous injection with 6-month intervals, approval of its usage in stage 3-4 CKD and not having gastrointestinal side effects are advantages of denosumab. However, it has some disadvantages like requiring monitoring serum levels of calcium and vitamin D before each injection.

A few tumours are exceptionally stubborn to oral chemotherapy. The endurance of tumours in a few cases is helped by checkpoint immunomodulation to keep up the unevenness between resistant reconnaissance and disease cell division.