Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Apr 5;3(2):492-506.
doi: 10.1002/jha2.427. eCollection 2022 May.

A review of the incidence of tumor lysis syndrome in patients with chronic lymphocytic leukemia treated with venetoclax and debulking strategies

Jeffrey P Sharman  1 , Juliana M L Biondo  2 , Michelle Boyer  3 , Kirsten Fischer  4 , Michael Hallek  4 , Dingfeng Jiang  5 , Arnon P Kater  6 , Michele Porro Lurà  7 , William G Wierda  8
Affiliations
Review

A review of the incidence of tumor lysis syndrome in patients with chronic lymphocytic leukemia treated with venetoclax and debulking strategies

Jeffrey P Sharman et al. EJHaem. .

Abstract

We reviewed the literature (January 2010-June 2021) on the effectiveness of debulking strategies before venetoclax initiation in patients with chronic lymphocytic leukemia to reduce tumor burden, downgrade tumor lysis syndrome (TLS) risk, and avoid hospitalization. Low TLS incidence and reduced TLS risk based on tumor burden were reported following debulking in clinical trials. Real-world observational studies reporting debulking regimens recorded no TLS events, and those without debulking strategies had greater TLS incidence. Debulking prior to venetoclax considerably reduces TLS incidence. Further clinical trials and real-world studies may provide additional evidence on effectiveness of debulking in reducing TLS incidence and hospitalization need.

Keywords: chronic lymphocytic leukemia; debulking; hospitalization; tumor lysis syndrome; venetoclax.

PubMed Disclaimer

Conflict of interest statement

Jeffrey P. Sharman reports stock options with Centessa Pharmaceuticals; consultancy with AbbVie, AstraZeneca, Beigene, Bristol Myers Squibb, Lilly, Pharmacyclics, and TG Therapeutics; and membership on board of directors or advisory committees for Centessa Pharmaceuticals. Juliana M.L. Biondo is an employee of Genentech, Inc. and has stock ownership for F. Hoffmann‐La Roche Ltd. Michelle Boyer is an employee of F. Hoffmann‐La Roche Ltd. Kirsten Fischer received honoraria and held a consulting/advisory role from F. Hoffmann‐La Roche Ltd and AbbVie; and received travel grants, accommodations and expenses from F. Hoffmann‐La Roche Ltd. Michael Hallek received grants, non‐financial support and personal fees (honoraria, speaker's bureau and/or advisory board) from AbbVie, Celgene, F. Hoffmann‐La Roche Ltd, Gilead, Mundipharma, Janssen, and Pharmacyclics. Dingfeng Jiang is an employee of AbbVie; and may own AbbVie stock or stock options. Arnon P. Kater has held a consultant or advisory role for Biogeneration and LAVA; received honoraria from Celgene, F. Hoffmann‐La Roche Ltd./Genentech, Inc., AstraZeneca, and Janssen; and received research funding from Celgene, F. Hoffmann‐La Roche Ltd./Genentech, Inc., AstraZeneca, and Janssen. Michele Porro Lurà is an employee of F. Hoffmann‐La Roche Ltd; and has stock ownership for F. Hoffmann‐La Roche Ltd. William G. Wierda is employed by The University of Texas MD Anderson Cancer Center; and received research funding from AbbVie and Genentech, Inc; received travel accommodations and expenses from AbbVie and Genentech, Inc.

References

    1. Hallek M, Shanafelt TD, Eichhorst B. Chronic lymphocytic leukaemia. Lancet. 2018;391(10129):1524–37. - PubMed
    1. Burger JA, Tedeschi A, Barr PM, Robak T, Owen C, Ghia, P, et al. Ibrutinib as initial therapy for patients with chronic lymphocytic leukemia. N Engl J Med. 2015;373(25):2425–37. - PMC - PubMed
    1. Furman RR, Sharman JP, Coutre SE, Cheson BD, Pagel JM, Hillmen P, et al. Idelalisib and rituximab in relapsed chronic lymphocytic leukemia. N Engl J Med. 2014;370(11):997–1007. - PMC - PubMed
    1. Roberts AW, Davids MS, Pagel JM, Kahl BS, Puvvada SD, Gerecitano JF, et al. Targeting BCL2 with venetoclax in relapsed chronic lymphocytic leukemia. N Engl J Med. 2016;374(4):311–22. - PMC - PubMed
    1. Seymour JF, Kipps TJ, Eichhorst B, Hillmen P, D'Rozario J, Assouline S, et al. Venetoclax‐rituximab in relapsed or refractory chronic lymphocytic leukemia. N Engl J Med. 2018;378(12):1107–20. - PubMed