Treatment options CLL 73 year old male with AFib.

[grace2017]

Hello everyone I have a question. My Dad has CLL his WBC is 74,000. He has a swollen lymp node in his neck that is very large. He is 73 with AFib what drug is used for CLL safely with AFib the doctor is still watching my Dad ( watch &wait) He had RCHOP chemotherapy in 2014.

[cajunjeff]

Venetoclax and Gazyva would be a good option I think.

Ibrutinib might make his afib worse. Acalabrutinib is thought to have less risk of causing afib if a btk inhibitor is best. I personally would ask my doctor about venetoclax alone or in combination with gazyva.

[grace2017 in reply to cajunjeff]

Dear Cajunjeff thank you very much for letting me know. I'm concerned about my Dad I've read alot about these meds and heart issues. Is the one you mentioned is that chemo or chemo pills. How high does doctors let the wbc be before treatment.

[cajunjeff in reply to grace2017]

Venetoclax is an oral drug that is very tolerable for most people, even older people. Gazyva is an infusion. Some people have a reaction to the infusion but are able to reduce the infusion flow and work through it. They can be taken alone or in combination.

The wbc count alone rarely determines treatment

[grace2017 in reply to cajunjeff]

Thank you very much. Dad just feels bad and the lymph node in his neck is the size of a tangerine and it's grown from an egg to a tangerine in a month. The Pet scan was ok they don't suspect B cell again just not sure how long they will wait.

[cajunjeff in reply to grace2017]

Growing nodes that are causing symptoms are among things to be considered in time to treat. The wbc doubling rate would be more important than the static number. Going from 60k to 70k in six months would not be a big deal, going from 30k to 70k in six months would be among the indications for treatment.

I would ask his doctor when he/she predicts he will need treatment and what treatment he will suggest. The doctor ought to have some idea as to the answer to both questions if he has been seeing your dad for a while. They are certainly legitimate questions to ask.

[grace2017 in reply to cajunjeff]

Well, Dad's case is a little different. His WBC was 26,500 six months ago. Then my Mother got bladder cancer and currently in treatment chemotherapy as well she is a breast cancer patient too. The doctors at home could not treat her. I had to move her and Dad because I'm there only daughter no one else to help. I now have a new doctor for my Dad he said to wait 2 weeks then check Blood again then go from there. His numbers went from 26,500 to 74,000 in 6 months.

[cajunjeff in reply to grace2017]

Grace, I have been through this with my parents. Life is hard enough taking care of ourself without having to manage our parents problems too. You are a good daughter. I think the rapid rise in your dads wbc and his growing nodes are indications treatment is time or near time for him.

I am not a doctor but I would think venetoclax is a good choice for him. It’s an oral drug he can take at home and it’s super effective.

It is a drug that has to be carefully monitored to start out. It’s so effective and kills Cll cells so rapidly it can cause a serious problem. The doctors know how to monitor it and ramp it up slowly to avoid problems.

Acalabrutinib is another option that might require less monitoring. Supposedly it carries less risk of aggravating his afib than ibrutinib.

Good luck Grace. Your parents are lucky to have such a caring daughter. Jeff

[grace2017 in reply to cajunjeff]

Thank you very much Jeff. Your very kind. I just want to do what's best. Yes it's really hard. I never imagined things would be like this just do the best we can. I greatly appreciate you. Thank you for helping me. God bless you Jeff.

[larrymarion]

i was on ibrutinib for 5.5 years and have been on venetoclax for a year. a few thoughts about your dad's situation and the preceding comments, along with some questions to ask your dad's hemoc:

1) as others have noted, acalabrutinib (trade name Calquence) is definitely considered less risky, especially the afib issue. also shown to have fewer side effects in general. what does the hemoc think of acalabrutinib, especially comparing and contrasting the side effect profiles? some of the ibrutinib side effects may be a real problem for your dad, considering his home care situation?

2) Venetoclax is an extremely active drug for folks with high tumor loads. Your dad's CLL seems to be quite aggressive, especially that node growing so fast, etc. You should ask your dad's hemoc about venetoclax's risks for folks with high tumor loads like your dad. if he mentions the ramp up protocol to mitigate those risks, ask him about the relative risk of first using acalabrutinib and then going to venetoclax.

[grace2017 in reply to larrymarion]

Dear Larrymarion, thank you very much for the information. I sure will ask the doctor I have alot of questions ready. Both my parents are cancer patients and my Mother has Chemotherapy Monday at the cancer center we go to. I greatly appreciate you. I hope they will help me soon it's very concerning to me. My Dad is under more stress right now than ever with my Mother so sick. Praying hard for both of them. Thank you again.