Tumour lysis syndrome is a rare group of metabolic complications that can occur when a large number of tumor cells enter the bloodstream. The syndrome is often linked to the treatment of haematological malignancies; in particular, aggressive leukaemias and lymphomas.
Although tumour lysis syndrome is generally uncommon in chronic lymphocytic leukaemia treated with standard chemoimmunotherapy, it can be associated with targeted therapy with the small molecule inhibitor against BCL. This is why prophylactic and risk mitigation measures could be applied when initiating venetoclax in patients with chronic lymphocytic leukaemia.
The mainstay of risk mitigation in this setting is risk assessment and risk-directed prophylaxis and monitoring; debulking strategies have also been proposed for risk reduction. These measures have resulted in safer initiation of venetoclax. Laboratory tumour lysis syndrome could be reduced to less than 4% of the patients and clinical tumour lysis could largely be avoided.
The BCL-2 inhibitor venetoclax has a high anti-tumour activity in chronic lymphocytic leukaemia, achieving deep remissions by potently inducing apoptosis. By prophylaxis and risk monitoring , venetoclax may be suitable for a wider group of patients.