Similar to chemotherapy, myelosuppression and gastrointestinal (GI) toxicities are common in patients with acute myeloid leukemia (AML) receiving venetoclax (Venclexta), explains Ilene Galinsky, BSN, MSN, ANP-C.

Galinsky recently presented on the topic of

practical treatment considerations with BCL2 inhibitors at the 47th Annual Oncology Nursing Society Congress. In an interview with 

 she discusses different management strategies for patients who experience adverse events with the therapy.

Patients who experience myelosuppression may become transfusion dependent, according to Galsinky. Therefore, it is advisable to bring patients in twice weekly for lab assessments, and potentially transfusions, during their first month of treatment with venetoclax.

Neutropenia is also a risk factor for patients receiving the BCL2 inhibitor, and it can significantly increase their risk of infection. Some providers may prescribe prophylactic antibiotic therapy if their patients develop neutropenia.

“In my institute, we do not do that,” Galinksy says. “It is not wrong to do that, but if you do, you have to be mindful that you [will] have to decrease the dose of venetoclax.”


Finally, grade 1/2 GI toxicities are common in this treatment population. Antiemetics or antidiarrheals may be effective symptom reduction strategies; however, some patients may also benefit from taking medication at different times of day.

“It is recommended to take [venetoclax] in the morning, but, in my experience, some [individuals] have found that they have less GI toxicities when they take it later in the day,” she says. “If they are not on a clinical trial, I let patients [experiment to find] what works best for them.”

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Ilene Galinsky, BSN, MSN, ANP-C, underscores effective symptom management strategies when prescribing venetoclax to patients with acute myeloid leukemia. 

Galinsky Breaks Down Venetoclax Symptom Management in AML

The risk factors associated with venetoclax (Venclexta) differ for patients with acute myeloid leukemia (AML) compared with other hematologic malignancies, such as chronic lymphocytic leukemia and multiple myeloma, explains Ilene Galinsky, BSN, MSN, ANP-C.

Galinsky, who is the senior leukemia protocol research nurse practitioner, at Dana-Farber Cancer Institute, presented on the efficacy and practical treatment considerations with BCL2 inhibitors at the 47th Annual Oncology Nursing Society Congress. In an interview with 

 she highlights optimal dosing strategies with venetoclax.

Important factors to consider include a patient’s disease burden and concomitant medications, Galinsky said. Venetoclax should not be initiated if a patient has a high white blood count and hydroxyurea should be used to achieve counts below 25,000 cells/μL. Further, tumor lysis syndrome, though rare, has been observed with venetoclax, and providers should closely monitor patients’ hydration levels during ramp up to reduce that risk of occurrence.

CYP3A4 inhibitors can also affect the pharmacokinetics of venetoclax, she said. If a patient is receiving one of those drugs, dose modifications may be necessary to get the patient to their target venetoclax dose.

Another important consideration is the likelihood of myelosuppression, she added. A mid-cycle bone marrow biopsy is recommended between days 21 to 28 to dictate if–and when–the second 28-day cycle can begin.

If a patient is not in remission after 1 cycle, treatment should be continued despite low blood counts, and a second barrow biopsy should be repeated, she said. If a patient is in remission, and has neutropenia, providers should wait until the patient has recovered to grade 1 or 2 neutropenia before initiating a second dose. If, following a second dose, neutropenia is persisting, providers should hold the dose and, upon resuming, prescribe a 21-day cycle instead of a 28-day cycle.

Ilene Galinsky, BSN, MSN, ANP-C, senior leukemia protocol research nurse practitioner at Dana-Farber Cancer Institute, underscores key prescribing considerations with venetoclax. 

Ilene Galinsky Highlights Optimal Venetoclax Dosing Strategies in AML

Ilene Galinsky, BSN, MSN, ANP-C, senior leukemia protocol research nurse practitioner, at Dana Farber Cancer Institute, discusses how treatment for patients with acute myeloid leukemia (AML) has evolved in recent years.

It is a very exciting to be a nurse or nurse practitioner in oncology, Galinksy explained, especially with the advances in therapeutics for patients with AML. These novel therapies are now less toxic compared with 7+3 chemotherapy, which patients would previously receive regardless of their molecular makeup. 

The evolution in science has also led to identification of molecular abnormalities and ways to target these aberrations through treatment, Galinsky explains. These precision medicine approaches have led to improvements in overall survival as well as quality of life, she concludes. 

Ilene Galinsky, BSN, MSN, ANP-C, senior leukemia protocol research nurse practitioner, at Dana Farber Cancer Institute, discusses how treatment for patients with acute myeloid leukemia has evolved in recent years. 

Ilene Galinsky, BSN, MSN, ANP-C

Articles

Galinsky Breaks Down Venetoclax Symptom Management in AML

Ilene Galinsky Highlights Optimal Venetoclax Dosing Strategies in AML

Ilene Galinsky Highlights Evolution of AML Treatment