RESUMO
Venetoclax, a highly selective, oral B-cell lymphoma 2 inhibitor, provides a robust targeted-therapy option for the treatment of chronic lymphocytic leukemia (CLL), including patients with high-risk del(17p)/mutated-TP53 and immunoglobulin heavy variable region unmutated CLL and those refractory to chemoimmunotherapy across all age groups. Due to the potent pro-apoptotic effect of venetoclax, treatment initiation carries a risk of tumor lysis syndrome (TLS). Prompt and appropriate management is needed to limit clinical TLS, which may entail serious adverse events and death. Venetoclax ramp-up involves gradual, stepwise increases in daily venetoclax dosing from 20 mg to 400 mg (target dose) over 5 weeks; adherence to on-label scheduling provides a tumor debulking phase, reducing the risk of TLS. The key components of safe venetoclax therapy involve assessment (radiographic evaluation and baseline blood chemistry), preparation (adequate hydration), and initiation (blood chemistry monitoring). In addition to summarizing the evidence for venetoclax's efficacy and safety, this review uses hypothetical patient scenarios based on risk level for TLS (high, medium, low) to share the authors' clinical experience with venetoclax initiation and present global approaches utilized in various treatment settings. These hypothetical scenarios highlight the importance of a multidisciplinary approach and shared decision-making, outlining best practices for venetoclax initiation and overall optimal treatment strategies in patients with CLL.
RESUMO
AIMS AND OBJECTIVES: To explore lymphoma survivors' experiences on their end of treatment and follow-up care at a large urban haematology centre in Ireland. METHODS: This was a qualitative study using semistructured interviews with lymphoma patients post-treatment (n = 14). Thematic analysis guided the analysis of interview data. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) guidelines. FINDINGS: Five main themes were identified following analysis of the interview data: dealing with uncertainty, changed relationships, returning to work, extended recovery time and concerns for the future. Findings of note were that some participants were unaware that their treatment had ended, many experienced recurrent infections which prolonged recovery time, and many had no recall of discussions on healthy lifestyle behaviours or recommended screening programmes at their follow-up visits. CONCLUSIONS: The findings suggest that the period of transition from active treatment to survivorship can be challenging for lymphoma survivors, and they experience ongoing needs. While the challenges of survivorship in lymphoma mirror those of other cancers, this cohort of patients require focused preparation for the end of active treatment and the transition to follow-up care. Moreover, this patient group requires repeated specific education on late effects and second cancers, education with regards to identifying the signs of cancer recurrence and promotion of healthy lifestyle practices. RELEVANCE TO CLINICAL PRACTICE: This study highlights the importance of a dedicated end of treatment visit with the clinical nurse specialist to confirm the completion of active treatment with lymphoma patients and focus on health promotion.
