Neutropenia on Venetoclax

[ontheblock]

Neutropenia on Venetoclax. How long does it last and what r treatment options

[Cllcanada Top Poster CURE Hero]

Are you on full dose Venclexta (venetoclax)? or still on the ramp?

Neutropenia is monitored and should levels drop to .5 or so, and stay suppressed then granulocyte growth factor injections might be used... C-GSFs like neulasta, neuprogen etc.

en.m.wikipedia.org/wiki/Gra...

Everyone is different.. but as the bone marrow clears, you neutrophils counts should rise and stablize.

While you are neutropenic you need to be careful about bacterial infections from food... and if the count drops to .5 or lower then a neutropenic diet would be advised... Wash all surfaces in kitchen and bathroom, with bleach and follow with hydrogen peroxide... I alternate days.

Be careful of probiotics etc.

If you are neutropenic and start having a fever about 38C then head immediately to the emergency care...

Neutropenic diet

hillman.upmc.com/patients/c...

~chris

[ontheblock in reply to Cllcanada]

Thx on full dose about three months neutropenia just happened. Have had neulastin to raise levels Does it persist? Or should it recover? Would lowering dose of V help? What about development of MDS in this setting???

[Cllcanada Top Poster CURE Hero in reply to ontheblock]

As the bone marrow clears of B cells, then the neutrophils will have room to return to normal...

He is the drug label data...

Neutropenia

Grade 3 or 4 neutropenia developed in 64% (124/194) of patients treated with VENCLEXTA in combination with rituximab and in 63% (216/344) of patients treated with VENCLEXTA monotherapy. Febrile neutropenia occurred in 4% of patients treated with VENCLEXTA in combination with rituximab and in 6% of patients treated with VENCLEXTA monotherapy. Monitor complete blood counts throughout treatment. Interrupt dosing or reduce dose for severe neutropenia. Consider supportive measures including antimicrobials for signs of infection and use of growth factors (e.g., G-CSF).

I have no idea about MDS and venetoclax, it hasn't been around very long...

How is your thrombocytopenia?

~chris

[ontheblock in reply to Cllcanada]

Thrombocytopenia running 60-80 range. We r in unchartered waters. Gurus I see feel any dose less then 400/ d doesn’t give best results vis a vis long term pfs etc so r reluctant to lower dose. MDS raised as another possibility of neutro and thrombocytopenia BM tests underway to see if that is an issue seperate or in addition to V toxicity.

[thb4747]

Hi,

I posted about this a week ago. I’m 4 months into a Venetoclax trial (full dose) and my neutrophils went down to 0.3. I had 4 C-GSF injections while the Venetoclax was stopped and bounced back to 3.6. I just started Venetoclax again (after 8 days) at 300 mg rather than 400 mg and am continuing to inject 3 times a week. My situation is slightly complicated because I’m flying to a South Africa on 6 October. Yet to discuss what I’ll do while I’m there.

All the best,

Rob

[ontheblock in reply to thb4747]

Neulastin has alonger half life 14 days and maybe better option w long flight ahead Thanks for your story. Looks like we are in unchartered waters and we are the warriors who are leading the challenge of how to use these drugs in the real world.

[charliegirl]

Hello there.

I completed venetoclax ramp up just 4 days ago. I am receiving it as monotherapy through the NHS Cancer Drugs Fund. At week 3 (200mg) I developed neutropenia with count dropping to 0.6. I was started on daily G-CSF and last week (week 4) this brought my count up to 1.2. I have to continue daily injections until my next blood count in a couple of days. I am taking things a week at a time and hope this is a temporary problem. My lymphocyte count has dropped from around 30,000 to around 1 5!

My platelet count, previously around 150,000 has also dropped below 100,000. My haemoglobin was already low, between 72 and 80 due to autoimmune haemolytic anaemia (a complication of CLL and so I am also producing antibodies against red cells) and this has stayed low.

After some qualms I have accepted transfusion of 1 unit weekly over the last two weeks.

Certainly a rougher ride than I'd expected but the hope is that as CLL gets back under control my bone marrow and the AIHA wiĺ improve too.

Best wishes

Charlie Girl

[charliegirl in reply to charliegirl]

Reply I just sent muddled weeks of ramp up. Should have been weeks 4 and 5, rather than 3 and 4.

I must check what I have written more carefully!

CG

[ontheblock in reply to charliegirl]

Hang in there! M

[charliegirl in reply to ontheblock]

Thanks v much. I certainly intend to. I'm v fortunate to have been allowed this treatment and recognise it's still v early days with such a new drug. Happy to be part of the learning

CG

[E-Lynn]

My CLL expert doc at Stanford University told me neutropenia was the most common side effect of Venetoclax. I've been on it for 20 months and have not experienced it. I do have quite low ALC at .5 but no one is worried. Blood flow cytometry showed I am MRD-. It's an amazing drug so far.