Canterbury DHB

Context

Relapsed or Refractory Patients

No precise guidelines can be given here. The decision for or against further treatment and its intensity will depend on several factors including:

The patient's wishes must be taken into consideration. The choice of treatment will depend upon the aims of any therapy being considered, whether palliative or intensive.

For an individual perspective on this topic, see:

Venetoclax

Venetoclax is designed to block the function of the Bcl-2 protein. In phase I/II trials, the response rate in heavily pre-treated patients was around 80%, even in patients with del(17p).

Determine tumour lysis risk before starting treatment and before each dose increase.

Due to the high rate of tumour lysis, it is essential to have a dose ramp-up period with strict measures to detect and treat tumour lysis syndrome.

Blood tests are required before each dose increase, and at 6 to 8 hours and 24 hours after each dose increase with results turned around and checked within 1 hour.

In NZ, it has been funded by special authority since 2020 for relapsed/refractory CLL.

References

High dose methylprednisolone

Methylprednisolone (1 g/m2/day IV for 5 days), either alone or in combination with rituximab is an effective salvage regimen in patients who are refractory to fludarabine, have p53 abnormalities and/or have adverse cytogenetics. Infectious complications have been reported frequently including pneumonia, gram-negative septicaemia, pneumocystis and herpes viruses.

For further information on regimen and outcomes see:

Ibrutinib

About this Canterbury DHB document (5515):

Document Owner:

Andrew Butler (see Who's Who)

Last Reviewed:

September 2018

Next Review:

September 2021

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 5515