Ven + R dosing

[gogscll]

My dad will likely soon be starting venetoclax and rituximab in the UK after a bone marrow biopsy in a couple of weeks. He previously received ibrutinib (and rituximab) through the FLAIR trial and has been treatment free for four years. I am trying to get an understanding of how much time he will be in the hospital. From what I have read, the dose of venetoclax is increased over the first five weeks before rituximab is introduced (monthly infusions for six months?). I was wondering if he will need to spend any time in hospital when he first starts venetoclax? Thank you!

[AussieNeil Partner Administrator]

Here's the venclexta site for those previously treated for CLL/SLL : venclexta.com/previously-tr...

With respect to V+R, from the prescribing information highlights document rxabbvie.com/pdf/venclexta.pdf for Venetoclax In Combination with Rituximab

Start rituximab administration after the patient has completed the 5-week ramp-up dosing schedule for VENCLEXTA (see Table 1) and has received VENCLEXTA at the recommended dosage of 400 mg orally once daily for 7 days. Administer rituximab on Day 1 of each 28-day cycle for 6 cycles, at a dose of 375 mg/m2 intravenously for Cycle 1 and 500 mg/m2 intravenously for Cycles 2-6. Continue VENCLEXTA 400 mg orally once daily for 24 months from Cycle 1 Day 1 of rituximab.

The above PDF document contains a section 2.4 Risk Assessment and Prophylaxis for Tumor Lysis Syndrome containing Table 3. Recommended TLS Prophylaxis Based on Tumor Burden in Patients with CLL/SLL which should answer your questions about likely outpatient and hospital care, provided you have information on your father's lymph node sizes and ALC.

Neil

[gogscll in reply to AussieNeil]

Thank you so much for all of this helpful information, Neil. I don’t have that data for my dad but will hopefully find out more at his next appointment in a couple of weeks. Thanks again!

[Mijoed]

I am on V R but only one year as it is a first treatment I didn’t tolerate Obinutuzumab.

During the five week ramp up I had to attend the clinic as an outpatient for a blood test on day one and day two of each week. It involved a few hours each day, mostly waiting for blood test results.

Once the ramp up was complete, 28 days supply of Venetoclax were given after every Rituximab infusion. Rituximab is given slowly (takes most of the day) for the first cycle and, if tolerated well, the subsequent cycles are given at high rate - around two hours total.

Once the six Rituximab cycles were complete, I received two months and then three months supply of Venetoclax. I was requested to go in and have a blood test at the end of each cycle. I receive the results directly and was told the haematologist would call me if anything looked wrong.

[gogscll in reply to Mijoed]

Thanks so much for your reply! This is very helpful and I will pass it on to my dad. I hope that you are doing well. Thanks again!

[Stacky66]

Hi , I was also on Ibrutinib for approximately,6 years, stated venetoclax last year , I find it much better. The Rituximab I had was also for six months, the first time is the longest approximately 5 hours and it gets quicker each visit. I had zero side affects after or during the 6 months, hope that helps, good luck

[gogscll in reply to Stacky66]

Thank you! That is great to hear. I am happy to hear that it is going well for you!

[Stacky66 in reply to Stacky66]

The Venetoclax to begin with was a matter of collecting from hospital and a blood test , took a couple of hours, which was more down to waiting to be seen