@article{20d4ac770057439ab81a21b4e2a18ed1,
title = "Real-world outcomes and management strategies for venetoclax-treated chronic lymphocytic leukemia patients in the United States",
abstract = "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.",
author = "Mato, {Anthony R.} and Meghan Thompson and Allan, {John N.} and Brander, {Danielle M.} and Pagel, {John M.} and Ujjani, {Chaitra S.} and Hill, {Brian T.} and Nicole Lamanna and Frederick Lansigan and Ryan Jacobs and Mazyar Shadman and Skarbnik, {Alan P.} and Pu, {Jeffrey J.} and Barr, {Paul M.} and Sehgal, {Alison R.} and Cheson, {Bruce D.} and Zent, {Clive S.} and Tuncer, {Hande H.} and Schuster, {Stephen J.} and Pickens, {Peter V.} and Shah, {Nirav N.} and Andre Goy and Winter, {Allison M.} and Christine Garcia and Kaitlin Kennard and Krista Isaac and Colleen Dorsey and Gashonia, {Lisa M.} and Singavi, {Arun K.} and Roeker, {Lindsey E.} and Andrew Zelenetz and Annalynn Williams and Christina Howlett and Hanna Weissbrot and Naveed Ali and Sirin Khajavian and Andrea Sitlinger and Eve Tranchito and Joanna Rhodes and Joshua Felsenfeld and Neil Bailey and Bhavisha Patel and Burns, {Timothy F.} and Melissa Yacur and Mansi Malhotra and Jakub Svoboda and Furman, {Richard R.} and Chadi Nabhan",
note = "Funding Information: 1CLL Program, Leukemia Service, Division of Hematologic Oncology, Department of Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; 2Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA; 3New York Presbyterian & Weill Cornell, NY; 4Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC; 5Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA; 6Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, DC; 7Taussig Cancer Institute, Cleveland Clinic Foundation, OH; 8Columbia University Medical Center, New York, NY; 9Dartmouth-Hitchcock Medical Center, Lebanon, NH; 10Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC; 11University of Washington/Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, WA; 12John Theurer Cancer Center, Hackensack Meridian Health, NJ; 13Penn State Health, Hershey, PA; 14Wilmot Cancer Institute Division of Hematology/Oncology, University of Rochester Medical Center, NY; 15University of Pittsburgh Medical Center, PA; 16Tufts Medical Center, Boston, MA; 17Abington Hem. Onc. Assoc., Inc., Willow Grove, PA; 18Division of Hematology & Oncology, Medical College of Wisconsin, Brookfield, WI; 19Internal Medicine, Lankenau Medical Center, Wynnewood, PA; 20Washington Hospital Center, DC and 21Cardinal Health, Dublin, OH, USA Publisher Copyright: {\textcopyright}2018 Ferrata Storti Foundation.",
year = "2018",
month = aug,
day = "31",
doi = "10.3324/haematol.2018.193615",
language = "English (US)",
volume = "103",
pages = "1511--1517",
journal = "Haematologica",
issn = "0390-6078",
publisher = "Ferrata Storti Foundation",
number = "9",
}