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Zhang H, Liu J, Wu Q, Xia L. Venetoclax combined with decitabine induced tumor lysis syndrome in a young patient with acute myeloid leukemia: a case report and literature review. Anticancer Drugs 2024; 35:440-444. [PMID: 38386312 DOI: 10.1097/cad.0000000000001580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Venetoclax, in combination with hypomethylation agents (HMAs), is a novel treatment for leukemia patients with low chemotherapy tolerance. However, it has been reported to be a risk of causing tumor lysis syndrome (TLS) in chronic lymphocytic leukemia (CLL) and elderly acute myeloid leukemia (AML) patients. Here we report a rare case of a young adult AML patient who induced TLS after receiving a combination therapy of venetoclax with decitabine (DEC). A 36-year-old male patient presented with an unexplained fever and was diagnosed with AML-M5a. The patient was first treated with a combination of antibiotics, including voriconazole 300 mg Q12h. After the infection was relieved, he was treated with 100 mg venetoclax in combination with 75 mg/m 2 DEC. However, 12 h after the first treatment, he developed diarrhea, fatigue and other symptoms, and the laboratory results were consistent with the laboratory TLS. The patient stopped chemotherapy immediately, and TLS gradually improved after receiving rehydration, diuresis, dialysis and other treatments. Finally, the patient achieved complete remission. Based on the experience of this case and related studies, we recommend the prevention of TLS should not be limited to elderly patients taking venetoclax, and it is equally important in young patients. And reduce the dosage of venetoclax when using azole antifungal drugs.
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Affiliation(s)
- Hongyong Zhang
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Khouderchah CJ, Benitez LL, Marini BL, Fraga M, Pettit K, Burke PW, Bixby DL, Perissinotti AJ. Tumor lysis syndrome in patients with acute myeloid leukemia treated with venetoclax and hypomethylating agents with or without dose ramp-up. Leuk Lymphoma 2024; 65:228-234. [PMID: 37933203 DOI: 10.1080/10428194.2023.2276056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023]
Abstract
Venetoclax with hypomethylating agents (HMAs) is an important treatment for patients with acute myeloid leukemia (AML) who cannot tolerate intensive chemotherapy. However, there is limited data on the safety of venetoclax without a dose ramp-up in patients with AML. A retrospective cohort analysis of patients with AML treated with HMA/venetoclax (HMA/Ven) with or without a dose ramp-up, or HMA alone from 6/30/2014-8/22/2022 was conducted. The primary endpoint was the incidence of laboratory and/or clinical tumor lysis syndrome (TLS) by day 10. Of 225 patients, 111 patients received HMA alone or HMA/Ven with a dose ramp-up and 114 received HMA/Ven with no dose ramp-up. The incidence of TLS was similar between the control and no dose ramp-up groups, with rates of 5.4% and 5.3% respectively (p = 0.962). TLS incidence was comparable in patients with and without a dose ramp-up, suggesting that a dose ramp-up may not be mandatory in patients with AML.
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Affiliation(s)
- Christy J Khouderchah
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Lydia L Benitez
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, Michigan, USA
- University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
| | - Bernard L Marini
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, Michigan, USA
- University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
| | - Martina Fraga
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kristen Pettit
- Department of Internal Medicine and Division of Hematology and Oncology, Michigan Medicine, Ann Arbor, Michigan, USA
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Patrick W Burke
- Department of Internal Medicine and Division of Hematology and Oncology, Michigan Medicine, Ann Arbor, Michigan, USA
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Dale L Bixby
- Department of Internal Medicine and Division of Hematology and Oncology, Michigan Medicine, Ann Arbor, Michigan, USA
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Anthony J Perissinotti
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine, Ann Arbor, Michigan, USA
- University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
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Guo YS, Zhao CH, Hu DY, Shen K, Chen SN. [Venetoclax combined with hypomethylating agents induced tumor lysis syndrome in patients with acute leukemia: 7 cases report and literature review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:508-511. [PMID: 37550210 PMCID: PMC10450560 DOI: 10.3760/cma.j.issn.0253-2727.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Indexed: 08/09/2023]
Affiliation(s)
- Y S Guo
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - C H Zhao
- Department of Clinical Laboratory, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - D Y Hu
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - K Shen
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - S N Chen
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China Jiangsu Institute of Hematology, Suzhou 215006, China
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Tumor Lysis Syndrome and Infectious Complications During Treatment with Venetoclax Combined with Azacitidine or Decitabine in Patients with Acute Myeloid Leukemia. Leuk Res 2022; 117:106844. [DOI: 10.1016/j.leukres.2022.106844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/17/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022]
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Impact of Oncology Pharmacists on the Knowledge, Attitude, and Practices of Clinicians to Enhance Patient Engagement of Self-Administered Oral Oncolytics. PHARMACY 2021; 9:pharmacy9030130. [PMID: 34449698 PMCID: PMC8396350 DOI: 10.3390/pharmacy9030130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/09/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022] Open
Abstract
Oncology clinical pharmacists are uniquely positioned to make interventions to impact the knowledge, attitudes, and practices of clinicians as well as patient activation and engagement. To accomplish this goal, pharmacists can target health system-related, provider-related, and patient-related factors to enhance patient-centered care and drive behavioral health changes. Interventions that pharmacists must tackle include educating team members and patients on the medication acquisition process, communicating urgency of treatment, optimizing workflows, facilitating guideline recommendations, preventing, and managing treatment toxicities, and promoting patient self-advocacy through education and shared decision-making. As crucial members of the healthcare team, oncology pharmacists can simplify highly complex treatment regimens to facilitate and optimize patients’ ownership of their care. This narrative review will focus on the example of venetoclax treatment in acute myeloid leukemia to demonstrate the impact that pharmacists provide that leads to behavioral change of patients and clinicians.
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Zappasodi P, Brociner M, Merati G, Nizzoli ME, Roncoroni E, Boveri E, Castagnola C, Arcaini L. Venetoclax and azacytidine combination is an effective bridge to transplant strategy in relapsed/refractory acute myeloid leukemia patients. Ann Hematol 2020; 100:1111-1113. [PMID: 33175198 DOI: 10.1007/s00277-020-04333-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Affiliation(s)
- P Zappasodi
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, V.le Golgi, 19, 27100, Pavia, Italy.
| | - M Brociner
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - G Merati
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - M E Nizzoli
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - E Roncoroni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, V.le Golgi, 19, 27100, Pavia, Italy
| | - E Boveri
- Unit of Anatomic Pathology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - C Castagnola
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, V.le Golgi, 19, 27100, Pavia, Italy
| | - L Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, V.le Golgi, 19, 27100, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
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