How do you manage severe thrombocytopenia due to splenomegaly and bone marrow involvement in CLL when starting obinituzumab and venetoclax?

This is a tough question without any information about the case. I am assuming the patient is untreated. For this setting, there are really three options supported by randomized phase 3 trials. Venetoclax + Obinuzumab has a single randomized phase 3 trial that showed improved progression free survival when given to untreated CLL, although the hazard ratio for survival favored the control arm (chlorambucil + obinutuzumab) and the results with del(17)(p13.1) was significantly worse than any of the results with Bruton's tyrosine kinase inhibitors. There are now 5 fully published randomized phase 3 studies with either ibrutinib or acalabrutinib +/- CD20 antibody (rituximab or obinutuzumab) that showed improved PFS and all had either a survival ...