Exploring Rapid Dose Escalation of Venetoclax in Patients With CLL
Posted: Monday, November 16, 2020
Although venetoclax is an effective treatment among patients with chronic lymphocytic leukemia (CLL) who relapsed after B-cell receptor pathway inhibitors, a 5-week dose ramp-up is necessary to avoid the risk of tumor-lysis syndrome. However, many patients require a faster time to target dose than this regimen allows. Kerry A. Rogers, MD, of The Ohio State University, Newark, and colleagues found that rapid dose escalation of venetoclax may benefit a select number of patients with CLL. The results, published in Blood Advances, stressed the importance of close in-hospital monitoring and experienced treatment centers.
“Given this increased tumor-lysis syndrome rate, it is important to note that rapid dose escalation venetoclax is not a generalizable approach; it should be used only when necessary to achieve rapid disease control in patients with proliferative disease,” the researchers concluded.
The research team retrospectively analyzed 33 patients with CLL who received rapid dose escalation of venetoclax. All of the patients had received prior Bruton’s tyrosine kinase inhibitor therapy.
The median time to target dose was substantially faster with this strategy than with previous treatment regimens (9 days). Overall, 17 patients (52%) developed laboratory tumor-lysis syndrome, and 5 patients (15%) developed clinical tumor-lysis syndrome. Patients with a higher initial tumor burden appeared to be more likely to experience tumor-lysis syndrome.
Of note, a rapid decrease in absolute lymphocyte count between the pretreatment dose to 24 hours after the venetoclax dose of 10 × 103/μL seemed to be significantly associated with a higher risk of tumor-lysis syndrome (P = .02). Monitoring the rapidity with which the absolute lymphocyte count drops may help clinicians to predict toxic lysis syndrome and guide dose-escalation decisions among this patient population.
Disclosure: For full disclosures of the study authors, visit ashpublications.org.