What is your approach to CLL in patients with atrial fibrillation and/or on anticoagulation?

Topics: Hematologic Malignancies • Medical Oncology • Leukemia • CLL • Hematology • Hemostasis/Thrombosis • Cardiology

Do you feel comfortable with BTK inhibitors in these patients?

In ELEVATE-RR patients on a/c were excluded, and rate of atrial fibrillation in the acalabrutinib arm was highest in those with a-fib history (10 pts=40%, 6 with gr3+ toxicity.) Does this affect your use?

Answer from: Medical Oncologist at Academic Institution

Before the availability of venetoclax, the only approved targeted oral therapy for patients with CLL was ibrutinib. Given the lack of alternative options, patients with atrial fibrillation and/or patients on anticoagulation were treated with ibrutinib. Use of anticoagulation with ibrutinib can incre...

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Medical Oncologist at Virginia Cancer Spclsts PC
Should we stratify risk first? So if they are low...

Answer from: Medical Oncologist at Academic Institution

In a patient with atrial fibrillation, I would be comfortable initiating a BTKi especially with approval of the 2nd generation BTKi which has less impact on cardiac arrhythmias and/or risk of bleeding. I would be hesitant with starting ibrutinib, not for the atrial fibrillation as I have co-managed ...

Answer from: Medical Oncologist at Academic Institution

For CLL patients who have atrial fibrillation or a history of this, I would follow the approach of using one of the second generation BTKi (acalabrutinib or zanabrutinib) which have a lower frequency of provoking this complication than ibrutinib. For patients requiring anticoagulation for atrial fib...

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