Preventing and monitoring for tumor lysis syndrome and other toxicities of venetoclax during treatment of chronic lymphocytic leukemia

Hematology Am Soc Hematol Educ Program. 2020 Dec 4;2020(1):357-362. doi: 10.1182/hematology.2020000120.


Recent developments in the management of chronic lymphocytic leukemia (CLL) have moved the standard of care away from chemoimmunotherapy to targeted agents such as oral kinase inhibitors or BCL-2 antagonists, alone or in combination with anti-CD20 antibodies. Two different treatment approaches have evolved: continuous, indefinite treatment and, more recently, fixed-duration combination treatment. With venetoclax-based treatment, there is a requirement to follow the established guidelines for close monitoring during initiation and ramp up, to reduce the risk of tumor lysis syndrome. The patient's risk should be assessed before the initiation of venetoclax. Appropriate management strategies should be used, including uricosuric agents, hydration, and routine laboratory monitoring, per guidelines. With early identification, immediate management, and dose adjustments, we suggest that tumor lysis syndrome and other toxicities, such as neutropenia and infections, with venetoclax-based treatment can be dealt with successfully.

Publication types

  • Case Reports

MeSH terms

  • Agammaglobulinaemia Tyrosine Kinase / antagonists & inhibitors
  • Aged
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Antineoplastic Agents, Immunological / therapeutic use
  • Bridged Bicyclo Compounds, Heterocyclic / adverse effects*
  • Bridged Bicyclo Compounds, Heterocyclic / therapeutic use
  • Female
  • Humans
  • Leukemia, Lymphocytic, Chronic, B-Cell / drug therapy*
  • Protein Kinase Inhibitors / therapeutic use
  • Sulfonamides / adverse effects*
  • Sulfonamides / therapeutic use
  • Tumor Lysis Syndrome / etiology*
  • Tumor Lysis Syndrome / prevention & control*


  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents
  • Antineoplastic Agents, Immunological
  • Bridged Bicyclo Compounds, Heterocyclic
  • Protein Kinase Inhibitors
  • Sulfonamides
  • Agammaglobulinaemia Tyrosine Kinase
  • BTK protein, human
  • venetoclax
  • obinutuzumab