Outpatient initiation of venetoclax safe, feasible in acute myeloid leukaemia

Initiation of venetoclax for acute myeloid leukaemia (AML) in the outpatient setting with a pharmacist-led interdisciplinary protocol is both feasible and safe, reports a study.

A group of researchers conducted this single-arm, retrospective study of adult AML patients between 1 April 2019 and 30 June 2020 to assess the safety of initiating venetoclax in the outpatient setting.

Eighty-two patients received the study drug thus this period, of whom 47 (57 percent) were initiated in the outpatient setting. Forty-five patients (55 percent) received venetoclax as first-line treatment for AML, while 37 (45 percent) received the drug for relapsed/refractory AML.

Almost all patients (98 percent) had a successful initiation, defined as no hospitalizations secondary to tumour lysis syndrome (TLS) within 7 days of therapy initiation. One patient (2.1 percent) had TLS following the start of venetoclax therapy. TLS symptoms were managed during hospitalization, which warranted just 1 day of missed AML therapy.

Medication access had a median turnaround time of 3 days. In addition, eight patients (17 percent) were hospitalized within 7 days, with febrile neutropenia being the primary reason.

“Venetoclax is a treatment option in patients with AML in both the front-line and relapsed/refractory settings,” the researchers said. “Initiation of therapy has been previously restricted to the inpatient setting at some institutions due to a risk of TLS and limitations in medication access efficiency given the high cost of therapy.”