AF in patient receiving acalabrutinib
Patient info
Case details
Date of diagnosis:
Before current treatment
Case description:
*The start date of acalabrutinib was July 2024 (it was not possible to choose 2024 in the system).
The patient started second line treatment with acalabrutinib monotherapy due to thrombocytopenia. She had progressive lymphocytosis 2,5 years after first line treatment (Obinutuzumab-chlorambucil) (ALC 21000 on 6/2022, ALC 60000 on 6/2024) and then had progressive thrombocytopenia in the last three months. Five days after starting the treatment she developed AF. The cardiologist started apixaban and metoprolol. Her PLTS on 10/7/2024 were 84000 /μL.
Since she now has AF and receiving apixaban, should we change treatment to VenR or continue acalabrutinib?
2729
SOFIA CHATZILEONTIADOU
2024-07-11 13:13:00
AF in patient receiving acalabrutinib
*The start date of acalabrutinib was July 2024 (it was not possible to choose 2024 in the system).
The patient started second line treatment with acalabrutinib monotherapy due to thrombocytopenia. She had progressive lymphocytosis 2,5 years after first line treatment (Obinutuzumab-chlorambucil) (ALC 21000 on 6/2022, ALC 60000 on 6/2024) and then had progressive thrombocytopenia in the last three months. Five days after starting the treatment she developed AF. The cardiologist started apixaban and metoprolol. Her PLTS on 10/7/2024 were 84000 /μL.
Since she now has AF and receiving apixaban, should we change treatment to VenR or continue acalabrutinib?
Internal Board Messages
Please also see: Blood Adv. 2022 Sep 27; 6(18): 5516–5525: International consensus statement on the management of cardiovascular risk of Bruton’s tyrosine kinase inhibitors in CLL.
If a CLL patient develops atrial fibrillation (AF) while on acalabrutinib treatment, the guidelines generally recommend continuing acalabrutinib rather than stopping it, with appropriate management of the AF.
please see below the key points:
– Manage the AF while continuing acalabrutinib treatment. This may involve (A) Cardiology consultation, (B) Rate or rhythm control medications, (C) Anticoagulation if appropriate (considering the increased bleeding risk with BTK inhibitors), (D) Close monitoring of the patient’s cardiac status
The decision to continue or discontinue acalabrutinib should be individualized based on the severity of AF, the patient’s overall clinical status, and the risk-benefit assessment of continuing CLL treatment versus managing cardiovascular complications.
In cases where acalabrutinib needs to be discontinued due to severe or recurrent AF, alternative treatment options for CLL should be considered, such as venetoclax-based regimens or other targeted therapies.
Write your opinion:
Please also see: Blood Adv. 2022 Sep 27; 6(18): 5516–5525: International consensus statement on the management of cardiovascular risk of Bruton’s tyrosine kinase inhibitors in CLL.
If a CLL patient develops atrial fibrillation (AF) while on acalabrutinib treatment, the guidelines generally recommend continuing acalabrutinib rather than stopping it, with appropriate management of the AF.
please see below the key points:
– Manage the AF while continuing acalabrutinib treatment. This may involve (A) Cardiology consultation, (B) Rate or rhythm control medications, (C) Anticoagulation if appropriate (considering the increased bleeding risk with BTK inhibitors), (D) Close monitoring of the patient’s cardiac status
The decision to continue or discontinue acalabrutinib should be individualized based on the severity of AF, the patient’s overall clinical status, and the risk-benefit assessment of continuing CLL treatment versus managing cardiovascular complications.
In cases where acalabrutinib needs to be discontinued due to severe or recurrent AF, alternative treatment options for CLL should be considered, such as venetoclax-based regimens or other targeted therapies.
Write your opinion:
2729
2024-07-11 13:13:00
AF in patient receiving acalabrutinib
*The start date of acalabrutinib was July 2024 (it was not possible to choose 2024 in the system).
The patient started second line treatment with acalabrutinib monotherapy due to thrombocytopenia. She had progressive lymphocytosis 2,5 years after first line treatment (Obinutuzumab-chlorambucil) (ALC 21000 on 6/2022, ALC 60000 on 6/2024) and then had progressive thrombocytopenia in the last three months. Five days after starting the treatment she developed AF. The cardiologist started apixaban and metoprolol. Her PLTS on 10/7/2024 were 84000 /μL.
Since she now has AF and receiving apixaban, should we change treatment to VenR or continue acalabrutinib?
2729
SOFIA CHATZILEONTIADOU
2024-07-11 13:13:00
Adverse events after initial drug administration
Published