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Dose Modification Decision Charts




CLL

CLL Dose Modification Decision Chart

*GCSF can be considered in select patients depending on regimen


CLL DOSE MODIFICATION DURING RAMP UP WITH CYP3A INHIBITORS
Week 1 10mg Moderate CYP3A Inhibitors include but are not limited to:
Ciprofloxacin Erythromycin
Diltiazem Fluconazole
Dronedarone Verapamil
Week 2 20mg
Week 3 50mg
Week 4 100mg
Week 5 200mg
CLL Dosing with Strong CYP3A Inhibitors - Contraindicated during ramp up of venetoclax
Posaconazole with venetoclax - Dose reduce venetoclax to 70mg Steady Daily Dose
Other Strong CYP3A Inhibitors - Dose reduce venetoclax to 100mg Steady Daily Dose
In some cases, venetoclax treatment can be paused, CYP3A inhibitor is given for course of treatment, then venetoclax can be resumed 2-3 days after discontinuation of CYP3A inhibitor
Strong CYP3A Inhibitors include but are not limited to:
Clarithromycin Lopinavir
Indinavir Posaconazole
Itraconazole Ritonavir
Ketoconazole Voriconazole
DOSE REDUCTIONS FOR TLS AND OTHER TOXICITIES
Dose at Interruption Restart Dose
400mg 300mg
300mg 200mg
200mg 100mg
100mg 50mg
50mg 20mg
20mg 10mg
*Any dose interruption lasting more than 1 week during ramp up phase, or more than 2 weeks after completion of ramp up, reassess for TLS to determine if reinitiation with reduced dose is warranted
*Consider discontinuing venetoclax in patients who require dose reductions to < 100mg for more than 2 weeks

AML

AML Dose Modification Decision Chart

*For Grade 3-4 non-hematologic toxicities, interrupt venetoclax if toxicity not resolved with supportive care. Upon resolution to Grade 1 or baseline, resume venetoclax at same dose.

*Bone marrow assessment recommended at the end of Cycle 1 to measure response. After achieving remission, treatment should be delayed until counts recover


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