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Chronic Lymphocytic Leukemia
Real-world outcomes and management strategies for venetoclax-treated chronic lymphocytic leukemia patients in the United States
Ferrata Storti Foundation
Anthony R. Mato,1 Meghan Thompson,2 John N. Allan,3 Danielle M. Brander,4 John M. Pagel,5 Chaitra S. Ujjani,6 Brian T. Hill,7 Nicole Lamanna,8
Frederick Lansigan,9 Ryan Jacobs,10 Mazyar Shadman,11 Alan P. Skarbnik,12 Jeffrey J. Pu,13 Paul M. Barr,14 Alison R. Sehgal,15 Bruce D. Cheson,6
Clive S. Zent,14 Hande H. Tuncer,16 Stephen J. Schuster,2 Peter V. Pickens,17 Nirav N. Shah,18 Andre Goy,12 Allison M. Winter,7 Christine Garcia,15
Kaitlin Kennard,2 Krista Isaac,19 Colleen Dorsey,2 Lisa M. Gashonia,2
Arun K. Singavi,18 Lindsey E. Roeker,1 Andrew Zelenetz,1 Annalynn Williams,14 Christina Howlett,12 Hanna Weissbrot,8 Naveed Ali,17 Sirin Khajavian,11
Andrea Sitlinger,4 Eve Tranchito,7 Joanna Rhodes,2 Joshua Felsenfeld,3
Haematologica 2018 Volume 103(9):1511-1517
Neil Bailey,5 Bhavisha Patel,20 Timothy F. Burns,9 Melissa Yacur,13
Mansi Malhotra,16 Jakub Svoboda,2 Richard R. Furman3 and Chadi Nabhan21
ARM and MT contributed equally to this work.
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
ABSTRACT
Venetoclax is a BCL2 inhibitor approved for 17p-deleted 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 initi- ation, 89% received a B-cell receptor antagonist. For tumor lysis syn- drome 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 diar- rhea in 7.3%. The overall response rate to venetoclax was 72% (19.4% complete remission). With a median follow up of 7 months, median pro- gression free survival and overall survival for the entire cohort have not been reached. To date, 41 venetoclax treated patients have discontinued
Correspondence:
matoa@mskcc.org
Received: March 17, 2018. Accepted: June 5, 2018. Pre-published: June 7, 2018.
doi:10.3324/haematol.2018.193615
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/103/9/1511
©2018 Ferrata Storti Foundation
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haematologica | 2018; 103(9)
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