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Author: Admin | 2025-04-28
High tumor burden and comorbidities; reduced renal function further increases TLS risk. Assess risk for TLS; initiate appropriate TLS prophylactic management (eg, hydration and antihyperuricemic therapy); monitor blood chemistries closely and manage abnormalities promptly. May require treatment interruption and dose reduction. The risk for TLS may decrease as tumor burden decreases. Utilize more intensive measures (IV hydration, frequent monitoring, hospitalization) as the overall TLS risk increases. Concomitant use of strong or moderate CYP3A inhibitors or P-gp inhibitors at initiation or during ramp-up may increase the risk for TLS and requires venetoclax dosage modification.Disease related concerns:Hepatic impairment: Dosage adjustment recommended in patients with severe hepatic impairment. Monitor closely for toxicities. Multiple myeloma: In patients with relapsed or refractory multiple myeloma, an increase in mortality was noted when venetoclax was added to bortezomib and dexamethasone. Venetoclax is not approved for the treatment of multiple myeloma. Renal impairment: Patients with decreased renal function (CrCl Concurrent drug therapy issues:Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.Other warnings/precautions:Immunizations: Live vaccinations should not be administered prior to, during, or after venetoclax treatment until B-cell recovery occurs. Vaccines may be less effective. Monitoring ParametersCBC with differential (throughout treatment); blood chemistries (potassium, uric acid, phosphorus, calcium, and creatinine); pregnancy test (prior to treatment in females of reproductive potential); assess tumor burden, including radiographic evaluation (eg, CT scan) for tumor lysis syndrome (TLS) risk evaluation; monitor for signs/symptoms of infection. Monitor adherence.Blood chemistry monitoring in acute myeloid leukemia: Assess and correct pre-existing abnormalities prior to therapy initiation; monitor blood chemistries for TLS prior to first dose, 6 to 8 hours after each new dose during ramp-up, and 24 hours after reaching the final dose. Increased monitoring may be necessary in patients at high risk for TLS.Blood chemistry monitoring based on tumor burden/TLS risk in chronic lymphocytic leukemia/small lymphocytic lymphoma:Low risk (all lymph node 3) or medium risk (any lymph node 5 to 3): Prior to first dose, 6 to 8 hours, and 24 hours after first 20 mg and 50
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