Practical Strategies for Managing Side Effects of Venetoclax in CLL
Posted: Wednesday, February 3, 2021
Tumor-lysis syndrome and other adverse events may be successfully treated in patients with chronic lymphocytic leukemia (CLL) who receive venetoclax-based therapies via early identification, immediate management, and dose adjustments. The management of these potential toxicities was discussed in detail by Kirsten Fischer, MD, of the University Hospital Cologne, Germany, and colleagues in Hematology: The American Society of Hematology Education Program.
Venetoclax, a BH3-mimetic compound that works by selective antagonism of BCL2, promotes apoptosis in CLL cells. This antitumor activity makes venetoclax effective in the treatment of CLL, although it also increases the risk of tumor-lysis syndrome. Therefore, patients should be evaluated for their risk for tumor-lysis syndrome prior to treatment with venetoclax. Imaging can be used to estimate tumor burden and should be considered in conjunction with renal function to estimate a patient’s risk for development of tumor-lysis syndrome.
To reduce a patient’s risk for tumor-lysis syndrome from venetoclax therapy, pharmacologic debulking strategies have been used. Bruton’s tyrosine kinase inhibitors, anti-CD20 antibodies, and chemoimmunotherapy have all been shown to decrease the overall tumor burden and reduce an individual’s risk for tumor-lysis syndrome. In addition, treatment of patients with uric acid–lowering agents (such as allopurinol) and good hydration with 1 to 2 liters of water daily may help to mitigate an individual patient’s risk. Close monitoring of electrolytes, uric acid, and creatinine clearance should be used to detect signs of tumor-lysis syndrome.
Venetoclax has also been associated with neutropenia, which can be addressed using granulocyte colony-stimulating factor to promote neutrophil production, dose interruptions, or dose reduction. Of note, although venetoclax therapy increases the risk of serious infections, the incidence of opportunistic infections appears to be low, and no microbial prophylaxis is recommended. Diarrhea secondary to venetoclax therapy can be managed with supportive measures.
Disclosure: For a full list of authors’ disclosures, visit ncbi.nlm.nih.gov.
Hematology: The American Society of Hematology Education Program
