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Key Considerations for Initiating a Chronic Lymphocytic Leukemia Therapy

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Key Considerations for Initiating a Chronic Lymphocytic Leukemia Therapy

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Key Considerations for Initiating a Chronic Lymphocytic Leukemia Therapy
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How can you reduce the risk of tumor lysis syndrome when starting patients on a therapy for chronic lymphocytic leukemia? 

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  • Overview

    No matter whether you’re using venetoclax for chronic lymphocytic leukemia in the first-line or
    relapsed/refractory setting, there are some important considerations to keep in mind, like its dose ramp-up as well as the importance of hydration and tumor lysis syndrome prophylaxis. Tune in as Dr. Lisa Nodzon, advanced oncology certified nurse practitioner in the Department of Malignant Hematology at Moffitt Cancer Center, reviews those key considerations and more.

  • Venetoclax Indication and Safety Overview

    Indication 

    • Venetoclax is a BCL-2 inhibitor indicated for the treatment of adult patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL).

    Contraindications

    • Strong CYP3A Inhibitors: Concomitant use with strong CYP3A inhibitors at initiation and during ramp-up phase in patients with CLL/SLL is contraindicated.

    Warnings and Precautions

    • TLS: Tumor lysis syndrome (TLS), including fatal events and renal failure requiring dialysis, has occurred in patients treated with venetoclax. Anticipate TLS; assess risk in all patients. Premedicate with anti-hyperuricemics and ensure adequate hydration. Employ more intensive measures (intravenous hydration, frequent monitoring, hospitalization) as overall risk increases.
    • Neutropenia: Monitor blood counts. Interrupt dosing and resume at same or reduced dose. Consider supportive care measures.
    • Infections: Fatal and serious infections such as pneumonia and sepsis have occurred in patients treated with venetoclax. Monitor patients for signs and symptoms of infection and treat promptly. Withhold venetoclax for Grade 3 and 4 infection until resolution and resume at same or reduced dose.
    • Immunization: Do not administer live attenuated vaccines prior to, during, or after venetoclax treatment until B-cell recovery.
    • Embryo-Fetal Toxicity: May cause embryo-fetal harm. Advise females of reproductive potential of the potential risk to a fetus and to use effective contraception.
    • Increased mortality in patients with multiple myeloma (MM) when venetoclax is added to bortezomib and dexamethasone. In a randomized trial in patients with relapsed or refractory MM, the addition of venetoclax to bortezomib plus dexamethasone, a use for which venetoclax is not indicated, resulted in increased mortality. Treatment of patients with MM with venetoclax in combination with bortezomib plus dexamethasone is not recommended outside of controlled clinical trials.

    Adverse Reactions

    • In CLL/SLL, the most common adverse reactions (≥20%) for venetoclax when given in combination with obinutuzumab or rituximab or as monotherapy were neutropenia, thrombocytopenia, anemia, diarrhea, nausea, upper respiratory tract infection, cough, musculoskeletal pain, fatigue, and edema.

    Review full prescribing information for additional information at www.rxabbvie.com or contact AbbVie Medical Information at 1-800-633-9110 or go to abbviemedinfo.com.

     BCL2-US-00023-MC
    Version 2.0, Approved January 2021

Programs 4/15/21