What Providers Need to Know About Helping Patients Manage CLL Therapy

By Cecilia Brown, Amber Koehler, MPAS, PA-C - Last Updated: November 15, 2023

As frontline therapy for patients with chronic lymphocytic leukemia (CLL) evolves, providers must be aware of potential side effects and how to help patients manage their treatment.

Amber Koehler, MPAS, PA-C, of the Mayo Clinic, explained that there are 2 main categories of frontline therapy for CLL, including Bruton’s tyrosine kinase (BTK) inhibitors and venetoclax-based therapies. She explained that each type of treatment comes with its own set of considerations and related side effects.

Regarding BTK inhibitors, “there are varying rates of side effects amongst each of these agents,” Ms. Koehler said, adding, “as a whole, the class effect we do see is cardiac arrhythmias and more specifically, atrial fibrillation.” This makes it critical to have a “low threshold for further workup” if a patient on a BTK inhibitor has concerning symptoms such as palpitations, a racing heart, or chest pain.

Ms. Koehler added that it’s important for nurses, advanced practice providers, and others caring for patients on BTK inhibitors to be aware that BTK inhibitors reversibly inhibit platelet function, meaning that patients are at a higher risk of bruising and bleeding. This makes it critical for patients to pause BTK inhibitor therapy for several days before certain invasive or surgical procedures.

When monitoring patients who are on time-limited venetoclax-based regimens, there are several critical considerations. “Monitoring and prevention of tumor lysis syndrome is critical,” Ms. Koehler said. “That’s why we do the dose escalation, weekly dose ramp-up, making sure people stay hydrated, making sure they’re taking allopurinol, making sure that they’re having appropriate lab monitoring per package insert at each of those steps is all-important in terms of decreasing that risk.”

Ms. Koehler also spoke about gastrointestinal side effects that can come with venetoclax-based regimens. It’s important to make sure that patients take the medication with food and take it in the evening rather than the morning. Ms. Koheler also noted that infection risk and neutropenia are important considerations with venetoclax-based therapies.

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