Real-world outcomes and management strategies for venetoclax-treated chronic lymphocytic leukemia patients in the United States Academic Article uri icon

Overview

MeSH Major

  • Boronic Acids
  • Lymphoma, Non-Hodgkin
  • Protease Inhibitors
  • Pyrazines

abstract

  • ©2018 Ferrata Storti Foundation. Venetoclax is a BCL2 in hibi to r approve d for 17p-delet ed relapsed/refractory chronic lymphocytic leukemia with activity following kinase inhibitors. We conducted a multicenter retro-spective cohort analysis of patients with chronic lymphocytic leukemia treated with venetoclax to describe outcomes, toxicities, and treatment selection following venetoclax discontinuation. A total of 141 chronic lymphocytic leukemia patients were included (98% relapsed/refractory). Median age at venetoclax initiation was 67 years (range 37-91), median prior therapies was 3 (0-11), 81% unmutated IGHV, 45% del(17p), and 26.8% complex karyotype (≥ 3 abnormalities). Prior to venetoclax initiation, 89% received a B-cell receptor antagonist. For tumor lysis syndrome prophylaxis, 93% received allopurinol, 92% normal saline, and 45% rasburicase. Dose escalation to the maximum recommended dose of 400 mg daily was achieved in 85% of patients. Adverse events of interest included neutropenia in 47.4%, thrombocytopenia in 36%, tumor lysis syndrome in 13.4%, neutropenic fever in 11.6%, and diarrhea in 7.3%. The overall response rate to venetoclax was 72% (19.4% complete remission). With a median follow up of 7 months, median progression free survival and overall survival for the entire cohort have not been reached. To date, 41 venetoclax treated patients have discontinued therapy and 24 have received a subsequent therapy, most commonly ibrutinib. In the largest clinical experience of venetoclax-treated chronic lymphocytic leukemia patients, the majority successfully completed and maintained a maximum recommended dose. Response rates and duration of response appear comparable to clinical trial data. Venetoclax was active in patients with mutations known to confer ibrutinib resistance. Optimal sequencing of newer chronic lymphocytic leukemia therapies requires further study.

authors

publication date

  • August 31, 2018

Research

keywords

  • Academic Article

Identity

Language

  • eng

PubMed Central ID

  • PMC6119152

Digital Object Identifier (DOI)

  • 10.3324/haematol.2018.193615

PubMed ID

  • 29880613

Additional Document Info

start page

  • 1511

end page

  • 1517

volume

  • 103

number

  • 9