Switching from ibrutinib to venetoclax in chronic lymphocytic leukemia: a management protocol based on clinical cases avoiding rapid disease progression

Abstract

Background: Some patients with chronic lymphocytic leukemia (CLL) terminate ibrutinib treatment due to toxicity or disease progression (DP). Initiation of other treatments may be associated with a rapid DP due to ibrutinib discontinuation.Objective: This study aims to successfully transition patients from ibrutinib-to venetoclax-based regimens through a clinical protocol that minimizes the risk for adverse outcomes. Methods: Four patients with CLL who progressed and required a transition were managed using our switch protocol which consists of a 5-week period during which the dose of ibrutinib is reduced and the dose of venetoclax increased on a weekly basis. Venetoclax is initiated at 20 mg daily with a weekly escalation to a maximum of 400 mg daily and ibrutinib is decreased over a 3-week period with a definitive suspension of treatment at week 4. Patients are monitored for the risk or onset of de lisis tumoral. Results: All patients were successfully transitioned without rapid DP or adverse events commonly associated with ibrutinib discontinuation. Conclusions: A 5-week transition protocol can be successfully applied for the transition of patients with CLL requiring a switch from ibrutinib to venetoclax due to toxicity or DP.