Heart Issues and Venclexta?

[KKwtx]

Has anyone had problems with their heart racing on Venclexta? My husband was diagnosed with CLL 17p deletion 53 mutation In 2018. Over the past 5, almost 6 years, he’s been treated with Ibrutinib, Venclexta, and Acalabrutinib. He’s had to discontinue all 3 because he couldn’t tolerate them for long. his doctor started him on Obinituzimab infusions in August and added Venclexta this past Tuesday at 20mg to ramp up to 100mg over the next 2 weeks. His heart started racing today. Anyone else experience this?

[Greenbunnies]

I have had a bit of this and I'm on V and O. For me I think it was linked to anaemia (which resolved quite quickly) and then more recently B12 deficiency.

[KKwtx in reply to Greenbunnies]

Thank you! We’ll ask about both next week!

[Cllsller]

No, but I had horrible headaches when I started taking venclexta. I too was on Ibrutinib and Acalabrutinib first. I think you should call his doctor immediately. Wishing you both good luck.

[KKwtx in reply to Cllsller]

Thank you! You as well!

[Newdawn Administrator]

Yes I did. A couple of days after stopping Ibrutinib but remaining on Venetoclax, I had a serious episode of tachycardia for which I was hospitalised. It wasn’t a haematology unit and they couldn’t even spell Venetoclax let alone understand its clinical mechanism.

Long story short, I had a battery of cardiac tests and thankfully no AF or abnormality was detected. I remain on beta blockers to keep it from surging as I was getting episodes of a heart rate around 169 without explanation.

Best wishes,

Newdawn

[KKwtx in reply to Newdawn]

Thanks so much. We’ve had the same experience here. No one has a clue what targeted therapy is when you go to the hospital or stand alone ER.

[SeymourB in reply to KKwtx]

KKwtx -

For us, a visit to the hospital requires that the ER/ED contact out hemo/onco as soon as possible. What I fear the most is an ER/ED visit on a weekend or holiday. Please address that with your hemo/onco, but expect an answer like, "Well, the answering service will try to contact the on-call hemo/onco, and they likely won't be familiar with your case."

Sigh. Taking my anxiety pill now.

=seymour=

[KKwtx in reply to SeymourB]

Right there with you😞

[SeymourB]

I'm on Venetoclax and Pirtobrutinib. I get somewhat tachy (100-120bpm) when I have a fever. Check his temperature.

The FDA insert, which is based on clinical trial data, doesn't mention tachycardia as a typical or even minor adverse effect.

accessdata.fda.gov/drugsatf...

HIGHLIGHTS OF PRESCRIBING INFORMATION - These highlights do not include all the information needed to use VENCLEXTA safely and effectively.

But it could be irregular heartbeat, which can feel like racing. The FDA insert definitely mentions that as a possibility of TLS (Tumor Lysis Syndrome) when first starting Venetoclax, especially if ALC is high, very enlarged lymph nodes or spleen, or high infiltration or cellularity in bone marrow. Usually, they do blood tests at each ramp up to check for high uric acid, high phosphorus, high potassium, and low calcium. Is he getting those tests?

my.clevelandclinic.org/heal...

Tumor Lysis Syndrome

Note that low calcium on those tests is associated with irregular rhythm. Don't just boost calcium without checking the test, though - high calcium can cause other problems.

=seymour=

[KKwtx in reply to SeymourB]

Yes, he is being monitored closely for TLS and so far, all those counts look good. We’ll go back Tuesday for more testing and ramp up to 50 mg. Have any of you had bad fatigue with this too? Not sure if it’s the Venclexta or O infusions causing that, but hoping it subsides with time. Thank you for replying!