DR LOVE: We were talking before about venetoclax. And I’m curious what your experience is. I think there’s a lot of, maybe, concern about what people have heard about tumor lysis syndromes. For practical purposes, what’s it like to use the drug? How do patients do on it?

DR SEHN: So I have to say, in my own clinic, because venetoclax is just on the verge of approval here in Canada, I’ve only had access to it in the context of clinical trials. We know for patients with CLL and possibly higher tumor burden, high-grade lymphomas, that tumor lysis syndrome is a definite risk with that drug.

As it rolls out into the clinic and it’s starting to be used more commonly now, I think that individual doctors are going to need to have a strategy for assessing the risk of tumor lysis syndrome in individual patients and then managing that patient accordingly, particularly in their first cycle. So the good thing is that this is generally a risk only within the initiation of treatment, and that risk goes away shortly thereafter. But with the initial dosing of the drug, there does need to be a strategy in place of identifying higher-risk patients and then monitoring for the risk of tumor lysis syndrome.

As part of the roll-out of this drug, the company has created guidelines. There are a lot of tools out there available for physicians to use to provide guidance as to how to manage these patients. But in patients who are at a higher risk — and sometimes the recommendation may be to admit them to hospital or to treat them in a situation where you can actually get sequential laboratory investigations to monitor for tumor lysis syndrome. So we’re actually currently grappling with this.

We’re on the verge of having access to venetoclax in the routine management setting. And we’re trying to create algorithms and management policies that allow us to identify the higher-risk patients. We may need to admit some of these patients to hospital or treat them in day units strategically, where they’re able to get sequential labs.

Fortunately, outside of CLL, it’s a relatively small risk for patients with non-Hodgkin lymphoma. So if we start to see that this drug has additional indications in mantle cell lymphoma or other non-Hodgkin lymphoma, follicular lymphoma, possibly, inevitably, maybe that risk will be lower, but in the short term, where most people will be using it for CLL patients, that risk is definitely there. And patients will need to be managed accordingly.

Non-Hodgkin lymphoma (NHL), Hodgkin lymphoma and chronic lymphocytic leukemia (CLL)

Acute and chronic leukemias and myeloproliferative neoplasms

Multiple myeloma (MM)