VIDEO: Addressing potential complications in CLL

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The point of following patients closely on active surveillance are to intervene before significant complications occur. We try to maximize the amount of time that a patient is free of any problems from their cancer, but intervene before there are any significant problems. So we have the iwCLL criteria for treatment that we follow in order to standardize who does and does not need treatment for CLL. But if disease is left unchecked, of course, it can cause significant cytopenias and result in problems from that. And of course, progressive enlarged lymph nodes can cause a host of different problems in terms of pain, but also end organ damage if there's compression, you know, internally on certain organ systems. In terms of treatment, we have to be aware of the side effect profiles of the treatments that we use.

I think covalent BTK inhibitors, most notably, have their cardiac toxicities. Luckily, acalabrutinib and zanabrutinib have less atrial fibrillation and arrhythmias, both supraventricular and ventricular than what ibrutinib has reported, so that's good. We've improved things there, but there still is issues like hypertension, bleeding that we have to watch out for. Infections is always a burden of both treated and untreated CLL patients, and that's something we have to be aware of, particularly in the COVID era. On the venetoclax side, you know, particularly if a patient presents with a high disease burden, we have to be certainly mindful of the potential for tumor lysis, either from the obinutuzumab (Gazyva; Genentech) on its own or ultimately the venetoclax that we pair with obinutuzumab when we treat patients with that approach.