Various factors
increase the risk of
developing TLS^1-3

Patients with high uric acid levels (>8.0 mg/dL) are at high risk for developing TLS

Relationship between uric acid level and development of TLS in patients with hematologic malignancies⁴*

Certain anticancer agents have been associated with elevated uric acid or TLS^6-28

^†This is not a comprehensive list of agents.

^‡There is an increased risk of severe skin toxicity when bendamustine HCl is used concomitantly with allopurinol.

^§Components of the R-CHOP regimen. R=rituximab, C=cyclophosphamide, H=doxorubicin hydrochloride (hydroxydaunomycin), O=vincristine sulfate (Oncovin^®), P=prednisone.

Venetoclax therapy and TLS

The National Comprehensive Cancer Network (NCCN^®) has specifically developed a set of supportive care recommendations for TLS in patients with CLL or SLL who have been prescribed venetoclax therapy¹

• Venetoclax can cause a rapid reduction of the tumor, thus increasing risk for TLS⁶
• In patients with CLL who followed the current (5 week) dose ramp-up and the TLS prophylaxis and monitoring measures, the rate of TLS was 2% in the venetoclax CLL monotherapy studies. With a 2 to 3 week dose ramp-up and higher starting dose in patients with CLL/SLL, the TLS rate was 13% and included deaths and renal failure⁶
• The risk of TLS is a continuum based on multiple factors, including tumor burden and comorbidities. Patients should be assessed for risk and should receive appropriate prophylaxis for TLS, including hydration and antihyperuricemics. Monitor blood chemistries and manage abnormalities promptly. Interrupt dosing if needed. Employ more intensive measures (intravenous hydration, frequent monitoring, hospitalization) as overall risk increases⁶
• Please refer to venetoclax package insert for additional management considerations

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) recommend TLS prophylaxis and monitoring based on tumor burden in patients with CLL/SLL receiving venetoclax¹:

• Management of patients with CrCl <80 mL/min and medium tumor burden (any lymph node 5 cm to <10 cm or ALC ≥25 x 10⁹/L) as high risk for TLS
• Consider rasburicase for patients with both high tumor burden and elevated baseline uric acid^‖

^‖In patients receiving venetoclax therapy, high tumor burden is defined as any lymph node ≥10 cm or ALC ≥25 x10⁹/L and any lymph node ≥5 cm.

Certain malignancies are associated with increased risk for TLS

Patients with (but not limited to) these hematologic malignancies may be at risk for TLS²:

• Acute Iymphoblastic leukemia (ALL)
• Acute myeloid leukemia (AML)
• Chronic myeloid leukemia (CML)
• Burkitt lymphoma (BL)
• Diffuse large B-cell lymphoma (DLBCL)
• Multiple myeloma (MM)
• Chronic lymphocytic leukemia (CLL)