scholarly journals Preventing and monitoring for tumor lysis syndrome and other toxicities of venetoclax during treatment of chronic lymphocytic leukemia

Hematology ◽  
2020 ◽  
Vol 2020 (1) ◽  
pp. 357-362
Author(s):  
Kirsten Fischer ◽  
Othman Al-Sawaf ◽  
Michael Hallek
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Kinase Inhibitors ◽  
Management Strategies ◽  
Tumor Lysis Syndrome ◽  
Standard Of Care ◽  
Lymphocytic Leukemia ◽  
Close Monitoring ◽  
Tumor Lysis ◽  
Uricosuric Agents ◽  
Anti Cd20

Abstract Recent developments in the management of chronic lymphocytic leukemia (CLL) have moved the standard of care away from chemoimmunotherapy to targeted agents such as oral kinase inhibitors or BCL-2 antagonists, alone or in combination with anti-CD20 antibodies. Two different treatment approaches have evolved: continuous, indefinite treatment and, more recently, fixed-duration combination treatment. With venetoclax-based treatment, there is a requirement to follow the established guidelines for close monitoring during initiation and ramp up, to reduce the risk of tumor lysis syndrome. The patient’s risk should be assessed before the initiation of venetoclax. Appropriate management strategies should be used, including uricosuric agents, hydration, and routine laboratory monitoring, per guidelines. With early identification, immediate management, and dose adjustments, we suggest that tumor lysis syndrome and other toxicities, such as neutropenia and infections, with venetoclax-based treatment can be dealt with successfully.

scholarly journals Advanced Practice Perspectives on Preventing and Managing Tumor Lysis Syndrome and Neutropenia in Chronic Lymphocytic Leukemia

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Amy Goodrich, RN, MSN, CRNP
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Management Strategies ◽  
Tumor Lysis Syndrome ◽  
Lymphocytic Leukemia ◽  
Advanced Practice ◽  
Treatment Delays ◽  
Tumor Lysis ◽  
Proper Actions ◽  
General Management ◽  
Life Threatening

Tumor lysis syndrome (TLS) and neutropenia are significant toxicities in the treatment of chronic lymphocytic leukemia (CLL). Both TLS and neutropenia can lead to potentially life-threatening complications for patients with chronic lymphocytic leukemia undergoing antineoplastic therapy. This article focuses on diligent risk assessment, prophylaxis, early identification, monitoring, patient education, and prompt intervention for TLS and neutropenia. These are all necessary steps to reduce life-threatening complications. Guidelines are available for risk assessments for both TLS and neutropenia. Once risk is established, prophylaxis and monitoring recommendations can be found in available guidelines. There are no established guidelines or widely used decision-making standards for the treatment of clinical TLS. General management strategies are well documented in the literature, with some degree of customization to each individual patient. If fever occurs in the setting of neutropenia, there are well-established guidelines for management, including guidance on anti-infective agents and use of growth factors. In addition, awareness and proper actions regarding TLS and neutropenia are key to preventing treatment delays, dose reductions, or treatment discontinuation. Adequate planning for TLS and neutropenia is critical to optimize patient outcomes.

scholarly journals Entering the Era of Targeted Therapy for Chronic Lymphocytic Leukemia: Impact on the Practicing Clinician

2014 ◽  
Vol 32 (27) ◽  
pp. 3039-3047 ◽  
Author(s):  
John C. Byrd ◽  
Jeffrey J. Jones ◽  
Jennifer A. Woyach ◽  
Amy J. Johnson ◽  
Joseph M. Flynn
Keyword(s):  
Targeted Therapy ◽  
Chronic Lymphocytic Leukemia ◽  
Kinase Inhibitors ◽  
Standard Of Care ◽  
Cell Receptor ◽  
Initial Therapy ◽  
Current Data ◽  
Lymphocytic Leukemia ◽  
Phase Iii ◽  
Anti Cd20

PurposeChemoimmunotherapy has been the standard of care for chronic lymphocytic leukemia (CLL). However, the introduction of B-cell receptor (BCR) kinase inhibitors such as ibrutinib has the potential to eliminate the role of chemotherapy in the treatment of CLL. How to best incorporate old and new therapies for CLL in this landscape is increasingly complex.MethodsThis article reviews current data available to clinicians and integrates these data to provide a strategy that can be used to approach the treatment of CLL in the era of BCR signaling inhibitors.ResultsCurrent strategies separate patients based on age or functional status as well as genetics [presence or absence of del(17)(p13.1)]. In the era of targeted therapy, this will likely continue based on current available data. Phase III studies support chemoimmunotherapy as the initial standard therapy for patients without del(17)(p13.1). Choice of chemotherapy (fludarabine plus cyclophosphamide, bendamustine, or chlorambucil) and anti-CD20 antibody (rituximab, ofatumumab, or obinutuzumab) varies based on regimen and patient status. For patients with del(17)(p13.1), no standard initial therapy exists, although several options supported by phase II clinical trials (methylprednisolone plus alemtuzumab or ibrutinib) seem better than chemoimmunotherapy. Treatment of relapsed CLL seems to be best supported by ibrutinib-based therapy. Completion of trials with ibrutinib and other new agents in the near future will offer opportunity for chemotherapy-free treatment across all groups of CLL.ConclusionTherapy for CLL has evolved significantly over the past decade with introduction of targeted therapy for CLL. This has the potential to completely transform how CLL is treated in the future.

Tumor Lysis Syndrome/Tumor Flare Reaction in Lenalidomide-Treated Chronic Lymphocytic Leukemia

2007 ◽  
Vol 25 (31) ◽  
pp. 5047-5047 ◽  
Author(s):  
Laure A. Moutouh-de Parseval ◽  
Lilia Weiss ◽  
Robert J. DeLap ◽  
Robert D. Knight ◽  
Jerome B. Zeldis
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Tumor Lysis Syndrome ◽  
Lymphocytic Leukemia ◽  
Tumor Lysis ◽  
Flare Reaction

Tumor lysis syndrome: an uncommon complication of fludarabine therapy of chronic lymphocytic leukemia.

1998 ◽  
Vol 16 (7) ◽  
pp. 2313-2320 ◽  
Author(s):  
B D Cheson ◽  
J N Frame ◽  
D Vena ◽  
N Quashu ◽  
J M Sorensen
Keyword(s):  
High Risk ◽  
Chronic Lymphocytic Leukemia ◽  
Disease Duration ◽  
Tumor Lysis Syndrome ◽  
Laboratory Data ◽  
Lymphocytic Leukemia ◽  
Phase Ii Trials ◽  
Tumor Lysis ◽  
Laboratory Features

PURPOSE To quantify the incidence and severity of tumor lysis syndrome (TLS) as a consequence of fludarabine therapy in patients with advanced chronic lymphocytic leukemia (CLL). PATIENTS AND METHODS A retrospective review and questionnaire follow-up of clinical and laboratory data were performed on patients with intermediate or high-risk CLL on the National Cancer Institute Group C protocol or special exception mechanisms, or phase II trials of fludarabine, for whom adverse drug reports of TLS were available. Fludarabine was administered at a dose of 20 to 40 mg/m2 per day for 5 days at monthly intervals. RESULTS Among the 6,137 patients, TLS was suspected in 26 (0.42%), with clinical and laboratory features consistent with TLS present in 20 (0.33%). Prophylaxis against TLS had been administered to 60% of these patients. Clinical or laboratory features were similar to patients who did not develop TLS. Of the patients with TLS, 90% had high-risk CLL, 60 months of prior disease duration, with a median pretreatment WBC of 109 x 10(9)/L, two prior regimens, lymphadenopathy in 89%, splenomegaly and/or hepatomegaly in 90%. TLS developed on approximately day 7 and lasted a median of 9.5 days. Dialysis was required in 30% during the TLS episode; 20% of patients died during cycle one of fludarabine therapy with renal failure, and another 20% died of infection or congestive heart failure. Six patients were retreated with fludarabine without recurrent TLS. CONCLUSION TLS after fludarabine therapy is extremely uncommon, but may be associated with significant morbidity and mortality.

scholarly journals Chronic lymphocytic leukemia paradigm continues to be refined: news from the American Society of Hematology 2018 annual meeting

2019 ◽  
Vol 8 (2) ◽  
pp. IJH14
Author(s):  
Stefano Molica
Keyword(s):  
Monoclonal Antibody ◽  
Clinical Trials ◽  
Chronic Lymphocytic Leukemia ◽  
Standard Of Care ◽  
Lymphocytic Leukemia ◽  
Phase Iii ◽  
Phase Iii Trials ◽  
Prospective Phase ◽  
American Society ◽  
Anti Cd20

There were a number of important updates and advances presented at the 2018 Annual American Society of Hematology meeting. With respect to the treatment of chronic lymphocytic leukemia, the American Society of Hematology 2018 was notable for an improved understanding of ibrutinib-based therapies. In fact, three prospective Phase III trials presented at the meeting indicate, in turn, that ibrutinib alone, ibrutinib plus rituximab, or ibrutinib plus obinutuzumab, should be the new standard of care for chronic lymphocytic leukemia. However, additional clinical trials comparing chemo-immunotherapy with ibrutinib alone or in association with an anti-CD20 monoclonal antibody remain a reasonable avenue to complete results of these large studies.

Change in tumor lysis syndrome risk after lead-in treatment in a phase 1b/2 study of obinutuzumab, ibrutinib, and venetoclax for chronic lymphocytic leukemia.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. 7528-7528
Author(s):  
Kerry Anne Rogers ◽  
Ying Huang ◽  
Amy S. Ruppert ◽  
Todd Civils ◽  
Subhashish Das ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Tumor Lysis Syndrome ◽  
Lymphocytic Leukemia ◽  
Tumor Lysis ◽  
Phase 1B
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