Venetoclax rampup

[mickimauser11]

I read the other day that a doctor ramped up within one week. Does anyone know why? There was a study shortening rampup to 3 weeks by Dr. Davids but 1 week? The patient is 11q .

[lankisterguy Volunteer]

Hi mickimauser11,

-

That sounds scary unless the patient was hospitalized and having blood tests with STAT results every 4 hours around the clock. I would want to know the lab techs were alert on duty and aware that they were looking for evidence that could avoid a life threatening event.

-

When I did my ramp up, my CLL expert was most concerned about my lymph nodes containing most of the CLL cells and when the nodes emptied out, that could lead to TLS if the Venetoclax killed to many at one time.

-

Len

[SofiaDeo]

If the tumor load was very low, and other cell lines within normal limits, it might be reasonable. Especially if a CT scan verified small internal nodes. I would hope it was the patients' choice. A low ALC and verified small internal nodes might indicate the risk of TLS negligible. My understanding of the ramp up protocol is mostly because of the TLS risk, and only somewhat because of the potential effects on platelets, neuts, and RBC's. Many cancer meds with even more cell suppressing effects than V have no ramp up. If we can do a 1 week ramp up on select patients safely, that's great!

I wonder if this patient wanted to do the "early treat" option, as others are now asking, instead of having the mental problems of W&W. I know I technically did not meet the paramets for treatment, but insisted on starting well before my labwork was where others "normally" started. I told my local onc "I don't care what others do, I don't want this to take over my marrow to the point of affecting other cells before starting treatment. All the treatments affect those cells anyway, and if they go too low I might be in trouble". And the CLL study docs didn't say "oh your labs aren't anywhere needing treatment, we won't accept you."

[Bluepup60]

I had a fast ramp up done. After I came off my last drug, my numbers started rising rather rapidly, so they wanted to get going before I was more at risk of tumor lysis. I was ramped up to 200 in a week in the hospital, released, and then 400 the next week. It went really well with no reactions.

[Jujy]

My husband starts O/V treatment at Dana Farber in a couple of weeks. He was asked if he was interested in a trial for rapid ramp up of Venetoclax. He would have been inpatient for a week. After consideration, he declined because of prior liver and kidney issues.

[mickimauser11 in reply to Jujy]

I would have done the same there are trials where they shortened the rampup to three weeks but one week is extreme. Some don’t even need a full dose of Venetoclax although the 400 is commonly used.