Oncology nurses play a crucial role in caring for patients with high-risk chronic lymphocytic leukemia (CLL), especially those exploring treatment options like allogeneic hematopoietic stem cell transplantation (HSCT). Dr. Francesca Perutelli and her colleagues conducted research to assess the efficacy of venetoclax therapy in patients who experienced relapse after undergoing HSCT, a group often excluded from clinical trials due to limited data.
To address this knowledge gap, the research team initiated a comprehensive survey across 53 hematology centers in Italy, receiving responses from 35 centers. They identified 7 patients who had previously undergone allogeneic HSCT and later received second-line venetoclax therapy.
Upon careful review, the investigators found that prior allogeneic HSCT did not compromise the effectiveness of venetoclax therapy. Patients achieved objective responses without worsening graft-versus-host disease (GVHD), marking a significant breakthrough. These findings were presented at the 2023 Society of Hematologic Oncology Annual Meeting.
Before allogeneic HSCT, patients had undergone various treatments, including chemoimmunotherapy in 7 cases, ibrutinib in 5 cases, and idelalisib in 1 case. Notably, 3 out of the 7 patients had previously received venetoclax-based therapies before their HSCT. Venetoclax was administered as monotherapy in 6 patients and in combination with obinutuzumab in 1 patient, with daily doses ranging from 200-400 mg.
The report confirmed the safety of venetoclax therapy, with adverse events consistent with outcomes observed in clinical trials. Neutropenia and infections were reported in 5 patients. Remarkably, 5 patients with preexisting chronic GVHD experienced no exacerbation after starting venetoclax. In fact, 2 of these patients saw improvements in GVHD symptoms, while 3 were able to reduce their steroid doses. Only 1 patient developed GVHD during treatment, and none required additional immunosuppression.
Five out of the 7 patients achieved a clinical response. Among them, 2 patients achieved measurable residual disease in the bone marrow, and 2 others maintained sustained responses after 2 years of venetoclax therapy.
In summary, Dr. Perutelli and her colleagues presented the largest reported series of CLL patients treated with venetoclax following allogeneic HSCT. Their findings offer hope to heavily pretreated and high-risk patients, demonstrating that previous allogeneic HSCT does not compromise the sensitivity to venetoclax. This information empowers oncology nurses to consider venetoclax as a viable option for patients experiencing relapse after HSCT, potentially improving their treatment outcomes.
Perutelli F, Boccellato E, Catania G, et al. Venetoclax Therapy in Chronic Lymphocytic Leukemia Patients Relapsed After Allogeneic Hematopoietic Stem Cell Transplantation. Abstract CLL-347. Presented at the 11th Annual Meeting of the Society of Hematologic Oncology; September 6-9, 2023; Houston, Texas.