A CASE REPORT OF EXTREMES: THE STRIKING EFFICACY OF VENETOCLAX AND HIGH DOSE METHYLPREDNISOLONE RESCUE IN CLL

Péter Rajnics, MD Ph.D*, Péter Szörényi, MD, Ádám Kellner, MD, Balázs Kollár, MD, Éva Karádi, MD, B?dör Csaba, MD, Ph.D, Béla Kajtár, MD, Ph.D and Miklós Egyed, MD, Ph.D

ABSTRACT

Chronic lymphocytic leukemia (CLL) is a hematological disorder with a protracted course in the average case. The disease history of patients to be treated show a repetitive fashion speeding up in successive cycles: a clinically disease free status less and less insidiously metamorphose into a more aggressive progression that gives way to a dwindling regression following the subsequent line of therapy. The clinician has to cope with an even shorter disease lead time when treating patients carrying 17p deletion or TP53 mutation. Despite the encouraging efficacy of Bruton’s tyrosine kinase (BTK) and BCL-2 inhibitors, allogeneic bone marrow transplantation remains the only curative option for these patients. Our 50-year old male patient harboring 17p deletion presented an extremely rapid, eruptive disease progression after 28 months of BTKi therapy. The introduction of venetoclax treatment did not seem to reverse or even decelerate progression marked by prolymphocytic transformation, soaring peripheral blood ALC, and menacingly deteriorating lymphadenopathy and splenomegaly during dose ramp-up. The rapid enlargement of cervical lymph nodes leading to airway obstruction and cervical blood vessel compression necessitated a rescue of 1000 mg methylprednisolone supplementing venetoclax treatment. After massive clinical tumor lysis syndrome the patient achieved incomplete hematological remission within 3 days.

Keywords: Chronic lymphocytic leukemia prolymphocytic venetoclax treatment.