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“The involvement and vigilance of oncology nurses in patient education and safe implementation of the weekly dose ramp up of venetoclax is critical for this safe delivery,” explained Dr Seymour. Oncology nurses should be aware that infection rates were low with venetoclax despite frequent neutropenia. In addition, infections were largely restricted to the first 6 months of treatment and were much lower in the monotherapy phase once CLL disease control was achieved.

Despite recent improvements in the treatment of relapsed/refractory CLL, current approaches to targeted therapy achieve low complete remission rates and require continuous therapy indefinitely. The results of the MURANO study have the potential to change that paradigm with time-limited therapy after attainment of deep responses, as confirmed by MRD negativity.

“The vigilance and monitoring of dose ramp up for TLS issues is critical for safe delivery of this highly effective therapy,” Dr Seymour said. “Oncology nurses have a pivotal role in that domain, both in the areas of patient education so they are informed, empowered active partners in their care, as well as the timeliness and vigilance of monitoring and management of emerging TLS signals.”

Hematologic monitoring and education regarding the management of neutropenia are very important. The researchers cautioned that additional follow-up is warranted to determine the durability of the responses that were seen in the current trial.


Seymour JF, Kipps TJ, Eichhorst B, et al. Venetoclax–rituximab in relapsed or refractory chronic lymphocytic leukemia.cN Engl J Med.2018;378(12):1107-20.