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ASH (American Society of Hematology) Annual Conference is a chance for young researchers to present their research to a world audience. This is especially important in CLL where too many wrongly see chronic lymphocytic leukemia as a solved problem.
Dr. Lindsey Roeker is a hematology fellow at Memorial Sloane Kettering in NYC who is working on CLL research. We need more like Dr. Roeker who choose chronic lymphocytic leukemia as their career focus.
I interviewed her at ASH 2018 concerning her trial: Adverse Events, Patterns of Tumor Lysis Syndrome Prophylaxis and Management, and Dosing Patterns in a Large Cohort of Venetoclax Treated CLL Patients in Community and Academic Settings.
She reports to us on retrospective data on the use of venetoclax in the real world.
- Venetoclax use in the real world was reviewed in 297 patients with 169 from academic settings and 128 from the community settings in the USA and UK.
- Tumor Lysis Syndrome (TLS) has been a major concern in the initial trials, but since the clarifying recommendations about appropriate risk assessment and dose escalation included in the package insert, the risk has been largely mitigated when the guidelines are followed.
- This study confirmed the risk remains low with venetoclax use outside of clinical trials.
- This is likely because the pattern of use and the approach to preventing TLS was similar and appropriate in both the community and academic setting. In other words, the CLL treatment guidelines are being followed.
- Adverse events were as expected and similar in the community and the university setting.
- TLS occurred in 8.4% of patients (pts) (n=25/297).
- 17 were just abnormal labs results but 8 were clinically significant.
- There was 1 death from TLS.
- Low neutrophils (neutropenia) were seen in 40% on patients, but only 8% had the more dangerous neutropenic fever.
- The platelet count dipped below 100,000 in 29.2%.
- One out of four patients had some type of infection.
- Progression free survival (PFS) for chronic lymphocytic leukemia patients was not affected by:
- The need to hold the venetoclax.
- The need to take a lower dose than the recommended 400 mg a day.
Much to glean from this interview and the abstract.
First, while venetoclax is a potent drug with potentially serious side effects, especially tumor lysis syndrome and low blood counts, it can and is being safely used in the community for the most part.
Second, needing to hold the drug or even needing to go on a lower dose than the recommended 400 mg doesn’t seem to adversely affect outcomes.
This is encouraging news and means another powerful weapon in our CLL battle is being effectively and appropriately deployed. And the study effort was led by one of a new generation of CLL researchers.
The CLL Society is working on plans to financially support more young researchers to encourage them to dedicate their careers to CLL/SLL. If you can help with that effort, please reach out to us at support@CLLSociety.org
Here is a link to the abstract. http://www.bloodjournal.org/content/132/Suppl_1/4410
Here is my interview from ASH 2018 in San Diego, CA.
Thanks for reading.
We are all in this together