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-TP53and 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.
维奈克拉是一种高选择性口服B细胞淋巴瘤2抑制剂，为慢性淋巴细胞白血病（CLL）患者提供了强有力的靶向治疗选择，其适应人群包括高危del(17p)/TP53基因突变及免疫球蛋白重链可变区未突变型CLL患者，以及各年龄段对化学免疫治疗难治的患者。由于维奈克拉具有强效促凋亡作用，治疗启动阶段存在肿瘤溶解综合征（TLS）风险。需要及时采取适当管理措施以控制临床TLS的发生，该并发症可能导致严重不良事件甚至死亡。维奈克拉剂量递增方案要求在5周内将每日给药剂量从20 mg逐步增加至400 mg（目标剂量）；遵循规范给药方案可形成肿瘤减积阶段，从而降低TLS风险。安全实施维奈克拉治疗的关键环节包括评估（影像学检查与基线血液生化检测）、准备（充分水化）和启动（血液生化监测）。本文在总结维奈克拉疗效与安全性证据的基础上，通过基于TLS风险等级（高、中、低）构建的假设病例场景，分享了作者在维奈克拉启动治疗方面的临床经验，并展示了不同治疗环境中采用的全球性策略。这些假设场景凸显了多学科协作与共同决策的重要性，系统阐述了CLL患者启动维奈克拉治疗的最佳实践方案及整体优化治疗策略。
肿瘤(癌症)患者之家