Half dose of Acalabrutinib

[MikeOr]

Have any of you been transferred from a full to half dose of Acalabrutinib (1 pill a day) because the full dose caused infections ? If yes, did the half dose solved the infections, and was it still sufficient to treat CLL ?

[lankisterguy Volunteer]

Hi MikeOr,

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You can find several previous discussions on this issue by looking on this page for the box labeled: Related Posts

*Reduced dosing of acalabrutinib healthunlocked.com/cllsuppo...

*Reaction after first dose of Acalabrutinib healthunlocked.com/cllsuppo...

*Reduced DOSE of Acalabrutinib/Calquence healthunlocked.com/cllsuppo...

*Reduced Dose of Acalabrutinib healthunlocked.com/cllsuppo...

*Spike Results after 3 Full Moderna Vaccines While Taking a Full Dose Acalabrutinib healthunlocked.com/cllsuppo...

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Len

[MikeOr in reply to lankisterguy]

Thanks lankisterguy. I see quite a few folks say that 1 pill a day works. But I could not find the answer to my other question: was the dose reduction successful in eliminating infections, in cases when infections were the actual cause for this reduction ?

[AussieNeil Partner Administrator in reply to MikeOr]

Mike, I'm not sure if you have taken a shortcut, because your question is missing the key connective factor - neutropenia! I would rephrase your question thus:- "Have any of you been transferred from a full to half dose of Acalabrutinib (1 pill a day) because the full dose caused (neutropenia, putting you at increased risk of) infections ? If yes, did the half dose solve the (neutropenia, thereby reducing your risk of) infections, and was it still sufficient to treat CLL ?"

Unfortunately, with HealthUnlocked's unsophisticated search feature, adding neutropenia to HU search didn't help . lankisterguy filtered the best search returns for you.

Neil

[MikeOr in reply to AussieNeil]

Thanks AussieNeil. But I am not so sure that neutropenia (low absolute count of neutrophils) is the only factor causing infections on this medications. I think the neutrophil count might be normal, but the functioning of the immune system might still be subpar.

[AussieNeil Partner Administrator in reply to MikeOr]

Strickly speaking, it's bacteria, viruses, fungi, protozoa and the like that cause infections. Drugs generally increase our risk of infection, rather than cause it, by how they reduce our immunity, such as by causing neutropenia, or reducing our ability to make antibodies.

What kind of infections are you experiencing? There are specific adverse events which can appear like infections. Looking at the listed adverse events might help you better ask your question.

Neil

[Fowey2009 in reply to AussieNeil]

hello Neil.

My husband is in hospital at the moment having had several infections since starting acalabrutinib. His neutrophils have been well into the normal range for quite a while - better than they have ever been, so not sure it is neutropenia that is causing the infections?

They are currently trying to figure out what is going on.

Beryl

[AussieNeil Partner Administrator in reply to Fowey2009]

How high are your husband's neutrophils? Has your husband needed G-CSF shots lately? I'm wondering how much your husband's neutrophil production is a consequence of fighting an infection and how much has been forced.

There's still much more to learn about how the different BTK drugs help restore the immune system as a consequence of how selectively targeted they are. For example, it seems ibrutinib helps restore T cell function, which acalabrutinib doesn't do. Importantly, both should remove the immunosuppressive effect of CLL on the immune system.

Infections are draining; I hope your husband is soon on the mend.

Neil

[lankisterguy Volunteer]

Hi MikeOr,

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I agree that the functioning of our immune system IS subpar, but most of that is blamed on CLL itself.

And as AussieNeil says, these are not direct cause & effect, but rather a reduced immune response allows an opportunistic infection ( bacterial, viral or fungal) to get established.

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Beyond Neutropenia the only infections I recall being concurrent with some targeted therapies were lung fungal infections- especially Pneumocystis, but I doubt there is good data to indicate whether a lower dose reduced the incidence of that.

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Len

[skunkbay53]

My husband was taken down to 1 pill a day almost a year ago due to severe fatigue. He is still in a form of remission.

[Rogerinhorn2015]

Was transferred to one pill daily on Ibrutinib 6.5 yrs. ago. Still effective w/out incident. Good luck! Take care.

[onu1tadi2]

I have for 2 years now. In fact I started with half dose. My blood counts have stayed normal. Am 77 and have occadional Afib which is why i switched from ibrut to acalabrut. Still get Afib but not usually for long periods. Getting a C scan in Nov to see if any signs of CLL progression. Will post re results. (I took 2/3 ibrut dose previously for almost 3 years. With no disease progression.) Why are you reducing?

[MikeOr in reply to onu1tadi2]

Because my dad ran into infection 3 weeks after he started on the full dose of Acalabrutinib.

[AussieNeil Partner Administrator in reply to MikeOr]

It would help if you provided more information regarding your Dad's infections and treatment history. A good place for this, so you don't need to constantly repeat yourself, is in your bio. You can edit your bio via this link: https:/healthunlocked.com/profile/edit

I suggest you make it clear that you are a member because you are supporting your father, who has CLL.

From a quick scan of your past posts, I gather your Dad is about 85, was started on ibrutinib 3 years ago, then was switched to acalabrutinib because it was hoped that this would help with his low platelets (did it?). Now you are wondering if switching to a half dose of acalabrutinib will reduce his infection risk.

The usual reason for reducing the dose of BTKi drugs like ibrutinib and acalabrutinib is to reduce side effects, which are becoming intolerable. There's an understood increased risk of infection while on all CLL treatments. That's managed by assessing the patient's risk at the start of treatment - and I would expect during treatment, if infections become a concern, by prescribing prophylactic antibiotics and or prophylactic antivirals. These medications come with their own associated risks too. Don't forget that your Dad is getting older - all of us are, and our immune system effectiveness declines with age. CLL compromises our immune system in many different ways: healthunlocked.com/cllsuppo... After 3 years of treatment, your Dad's CLL tumour burden should be much reduced, but immune system recovery is uneven. Some aspects of our immunity never recover, for example, if your Dad's antibody/immunoglobulin levels are excessively low, he may qualify for IVIG or Subcutaneous IgG. I've heard of someone with CLL in their 90s on subcutaneous IgG.

Neil

[MikeOr in reply to AussieNeil]

Thanks AussieNeil. My dad, 85, was Dxed 10 years ago, started on Ibrutinib in January 2019, stopped in January 2021 due to infections. He started on Acalabrutinib about a month ago, with a prophylactic antiviral (acyclovir). Prophylactic antibiotoics seem like too extreme to me: one cannot stay on antibiotics for too long (I might be wrong, of course). But due to an infection he stopped Acalabrutinib until the symptoms resolve.

[AussieNeil Partner Administrator in reply to MikeOr]

What you have written above for your father, would help if included as his bio, with a note that you are his 'CLL Carer'. Please do consider adding this in via healthunlocked.com/profile/...

Some doctors do prescribe prophylactic antibiotics long term. One of my fellow trial members was on them. It's not desirable but it's preferable to dying from an infection!

People who have had splenectomies are permanently on antibiotics - yes, for life! Ask our volunteer PaulaS!

I appreciate there may be a quality vs quantity issue here. It's tough!

Neil