Vol 12, No 2 (2021)
Guidelines / Expert consensus
Published online: 2021-10-07

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Polish Experts’ Position Statement on the use of granulocyte colony-stimulating factor in the treatment of chronic lymphocytic leukemia with venetoclax combined with rituximab

Elżbieta Iskierka-Jażdżewska1, Krzysztof Giannopoulos2, Sebastian Grosicki3, Krzysztof Jamroziak4, Tomasz Wróbel5, Jan Maciej Zaucha6, Marek Dudziński7, Łukasz Bołkuń8, Ewa Bodzenta9, Joanna Drozd-Sokołowska10, Agnieszka Samborska11, Anna Wolska-Washer12, Iwona Hus13
Hematology in Clinical Practice 2021;12(2):67-71.

Abstract

Chronic lymphocytic leukaemia (CLL) is the most common adult leukaemia in Western countries. Venetoclax, a BCL-2 inhibitor, in combination with rituximab is an effective therapeutic option approved for the treatment of refractory and relapsed CLL. Neutropenia diagnosed before or during the above-mentioned therapy is a significant clinical problem, which often involves the need to reduce the dose or temporarily discontinue venetoclax in the initial period of therapy. In Experts’ opinion, the use of granulocyte colony-stimulating factor (G-CSF) during venetoclaxrituximab combined therapy is reasonable in patients with baseline neutrocyte count < 1000–500/mm3 and with high-risk neutropenia. The second important group for the use of G-CSF are patients developing grade 3 asymptomatic neutropenia during venetoclax dose escalation. Using G-CSF can prevent episodes that affect the maintenance of the venetoclax dose intensity and treatment continuity.

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References

  1. Brusamolino E, Bacigalupo A, Barosi G, et al. Classical Hodgkin's lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up. Haematologica. 2009; 94(4): 550–565.
  2. Hallek M, Shanafelt T, Eichhorst B. Chronic lymphocytic leukaemia. Lancet. 2018; 391(10129): 1524–1537.
  3. Tam CS, Stilgenbauer S. How best to manage patients with chronic lymphocytic leuekmia with 17p deletion and/or TP53 mutation? Leuk Lymphoma. 2015; 56(3): 587–593.
  4. Jaśkowiak K, Golicki D. Biała księga. Przewlekła białaczka limfocytowa. HealthQuest, Warszawa 2017. https://docplayer.pl/47519942-Biala-ksiega-przewlekla-bialaczka-limfocytowa.html (September 20, 2021).
  5. Kater AP, Seymour JF, Hillmen P, et al. Venetoclax-rituximab in relapsed or refractory chronic lymphocytic leukemia. N Engl J Med. 2018; 378(12): 1107–1120.
  6. Załącznik B.103. Leczenie przewlekłej białaczki limfocytowej wenetoklaksem (ICD 10: C91.1). https://hematoonkologia.pl/upload/programy-lekowe/B103_od_01-2019.pdf (September 20, 2021).
  7. Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. Published: November 27, 2017. U.S. Department of Health and Human Services. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_5x7.pdf (September 20, 2021).
  8. Kuderer NM, Dale DC, Crawford J, et al. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer. 2006; 106(10): 2258–2266.
  9. Pettengell R, Schwenkglenks M, Leonard R, et al. Impact of Neutropenia in Chemotherapy-European Study Group (INC-EU). Neutropenia occurrence and predictors of reduced chemotherapy delivery: results from the INC-EU prospective observational European neutropenia study. Support Care Cancer. 2008; 16(11): 1299–1309.
  10. Spławiński J. Growth factors in the prophilaxis and treatment of chemotherapy-induced neutropenia. Hematologia. 2014; 5(4): 272–284.
  11. Smith TJ, Bohlke K, Lyman GH, et al. American Society of Clinical Oncology. Recommendations for the use of WBC growth factors: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2015; 33(28): 3199–3212.



Hematology in Clinical Practice