Safe administration of venetoclax-obinutuzumab in a chronic lymphocytic leukemia patient with Brugada syndrome

Abstract

Brugada syndrome (BS) is a genetic condition that predisposes individuals to life-threatening arrhythmias, posing a challenge in the management of chronic lymphocytic leukemia (CLL). While BTK inhibitors have been associated with ventricular arrhythmias, data on the cardiac safety of venetoclax and obinutuzumab in BS patients remain limited. We describe the case of a 60-year-old CLL patient with a baseline type 2 Brugada ECG pattern who was treated with venetoclax plus obinutuzumab due to concerns over BTK inhibitor-associated cardiac risks. During the first obinutuzumab infusion, the patient experienced an infusion-related reaction with hypotension, hypokalemia, and transient conversion to a type 1 Brugada ECG pattern. Supportive measures, including electrolyte correction, led to ECG normalization. Venetoclax was well tolerated, and the patient achieved a complete response with undetectable measurable residual disease. This case underscores the importance of cardiac monitoring in CLL patients with BS and suggests that venetoclax plus obinutuzumab may represent a safe and effective therapeutic alternative when BTK inhibitors are contraindicated.