Evaluating the impact of a pharmacist-led venetoclax ramp-up clinic for chronic lymphocytic leukemia patients: A retrospective chart review

Abstract

Introduction

Venetoclax is a BCL-2 inhibitor, used for both treatment-naive, and relapsed/refractory chronic lymphocytic leukemia (CLL). To mitigate the risk of tumor lysis syndrome (TLS), a 5-week dose ramp-up strategy with frequent assessment is required. Pharmacists are medication experts and skilled in managing adverse effects. They are ideally positioned to manage patients during ramp-up and can reduce hematologist visits. We sought to describe the impact of a pharmacist-led venetoclax ramp-up clinic implemented at our institution.

Methods

The primary objective was to describe pharmacist interventions made during ramp-up to prevent TLS. Key secondary objectives included describing the rates of TLS and rates of venetoclax target dose achievement. The study was a retrospective electronic chart review including CLL patients with ≥1 visit to the pharmacist-led clinic between October 2020-January 2024. Data was collected using a standardized form and descriptive statistics were used for analysis.

Results

Eighty-eight patients were included. The median age was 70 years old and 97% of patients were low or moderate risk for TLS. Common interventions made for TLS prevention were education, occurring during all 907 patient visits, and changes to TLS prophylaxis, occurring during 113 (12.5%) patient visits. Two (2.3%) patients experienced laboratory TLS and 0 experienced clinical TLS. Eighty-three (94.3%) patients achieved target dose at the end of the study period.

Conclusions

The results of the study support that a pharmacist-led venetoclax clinic is both safe and effective for patients with CLL. Up-titration, active TLS prophylaxis, education and adverse event management are key components to the clinic.