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Safety of venetoclax rapid dose escalation in CLL patients previously treated with B-cell receptor signaling antagonists

Authors :
Shane Sheredy
Mollie E. Moran
Jennifer A. Woyach
Jill Ford
Emily Desmond
Kristin Lynn Koenig
John C. Byrd
Emily Dotson
Seema A. Bhat
Shauna Iarocci
Margaret S. Lucas
Kerry A. Rogers
Ying Huang
Tracy Wiczer
Jeffrey A. Jones
Farrukh T. Awan
Source :
Blood Adv
Publication Year :
2020

Abstract

Venetoclax has efficacy in patients relapsing after B-cell receptor pathway inhibitors (BCRis); however, because of the risk of tumor lysis syndrome (TLS), a 5-week dose ramp-up is required to attain the target dose. Patients relapsing after BCRis frequently have proliferative disease, requiring a faster time to target dose than this scheme allows. This limitation can potentially be overcome with rapid dose escalation (RDE). We analyzed 33 chronic lymphocytic leukemia patients who underwent venetoclax RDE after prior BTKi treatment. Median time to target dose was 9 days. Seventeen patients (52%) developed laboratory TLS, and 5 (15%) developed clinical TLS, all as a result of renal injury. TLS was seen in more patients with a higher initial tumor burden. TLS occurred at all dose levels, with most episodes occurring at the 50- and 100-mg doses. Most interestingly, a decrease in absolute lymphocyte count (ALC) from pre–venetoclax dose to 24 hours post–venetoclax dose of 10 × 103/μL was associated with an increased risk of TLS (hazard ratio, 1.32; P = .02), after controlling for venetoclax dose level. Venetoclax RDE with close in-hospital monitoring at experienced centers and in select patients is feasible. The rapidity with which ALC drops helps predict TLS and could help guide dose-escalation decisions.

Details

ISSN :
24739537
Volume :
4
Issue :
19
Database :
OpenAIRE
Journal :
Blood advances
Accession number :
edsair.doi.dedup.....a5e7a766200579fcd16dd74b31f4d703