Polish Experts’ Position Statement on the use of granulocyte colony-stimulating factor in the treatment of chronic lymphocytic leukemia with venetoclax combined with rituximab

Abstract

Chronic lymphocytic leukemia (CLL) is the most common adult leukemia in Western countries. Venetoclax, a BCL-2 inhibitor, in combination with rituximab is an effective therapeutic option approved for the treatment of refractory and relapsed CLL. Neutropenia diagnosed before or during the above-mentioned therapy is a significant clinical problem, which often involves the need to reduce the dose or temporarily discontinue venetoclax in the initial period of therapy. In Experts’ opinion, the use of granulocyte colony-stimulating factor (G-CSF) during venetoclax–rituximab combined therapy is reasonable in patients with baseline neutrocyte count < 1000–500/mm3 and with high-risk neutropenia. The second important group for the use of G-CSF are patients developing grade 3 asymptomatic neutropenia during venetoclax dose escalation. Using G-CSF can prevent episodes that affect the maintenance of the venetoclax dose intensity and treatment continuity.