Venetoclax + cytarabine

Your haematology team might recommend venetoclax + cytarabine for you if:

• You have been newly diagnosed with AML AND
• Intensive chemotherapy is not suitable for you

Sometimes venetoclax may be given with other medicines instead of cytarabine. Your medical team will let you know which combination of medicines you are taking.

We have separate information about venetoclax for CLL or combined with other medicines.

Ventoclax

Venetoclax is a targeted medicine that blocks a protein called BCL-2. This protein is present in some cancer cells. Blocking it can help kill cancer cells.

The brand name for venetoclax is Venclyxto.

Cytarabine

Cytarabine is a chemotherapy medicine that stops your cancer cells from making and repairing DNA. This can stop cancer cells from growing and dividing.

There is no brand name for cytarabine. You might hear some people call it Ara-C.

Back to top

Before starting venetoclax + cytarabine, your haematology team will carry out checks to make sure it is suitable for you. These might include:

• Blood tests to measure your blood counts
  • If your white blood cell count is too high, you might have treatment to lower it before starting venetoclax + cytarabine
• Blood tests to check your liver and kidney function, and the levels of salts in your body
• Bone marrow test

Things to tell your haematology team

Before starting treatment, you should let your haematology team know if you:

• Have kidney disease, liver disease or any problems with your liver
• Have recently had cancer treatment, radiotherapy or are due to have radiotherapy
• Have an infection, or have had a long-lasting or repeated infection

Some medicines or drugs may interact with venetoclax. It is important to tell your haematology team about any medicines or supplements you are taking. This includes prescribed medicines and medicines you have bought yourself without a prescription. Examples include:

• Herbal medicines, such as St John’s Wort
• Some antibiotic, antifungal and antiviral medicines
• Some medicines used to treat high blood pressure (including high blood pressure in your lungs)
• Modafinil, a medicine used to treat sleeping disorders
• Digoxin, a medicine used to treat heart failure or abnormal heart rhythms
• Dabigatran, a medicine used to treat and prevent blood clots and stroke

You will receive treatment in a cycle of 28 days. This is made up of some days where you will have venetoclax + cytarabine, and some days where you only have venetoclax.

Dose

Your haematology team will let you know what dose you are on, but below are the most common doses that are used.

Venetoclax

You start on a low dose of venetoclax. Your doctor usually increases the dose every day for 4 days until you reach the full dose. Most people have:

• Day 1: 100mg once a day
• Day 2: 200mg once a day
• Day 3: 400mg once a day
• Day 4 onwards: 600mg once a day

Cytarabine

Your doctor will work out the best dose of cytarabine for you based on your height, weight and how well you respond to treatment. They will tell you what dose they recommend for you.

Back to top

There are several precautions to be aware of when you are having venetoclax + cytarabine.

• Do not eat, drink or use supplements that contain grapefruit, Seville oranges (usually used in marmalade) or starfruit. This is because they can increase the amount of venetoclax in your blood.
• Tell your haematology team if you are due to have any vaccines. You should not have live vaccines when you are being treated with venetoclax + cytarabine. It is OK to have non-live vaccines, but they might not work as well as usual.

Back to top

Venetoclax + cytarabine may harm unborn babies.

• If you could get pregnant, it is important to use effective contraception. You need to do this while you are having venetoclax + cytarabine and for 6 months after you stop. The treatment might affect hormonal contraceptive pills or devices. So it is important to use a barrier method like a condom, diaphragm or cap.
• If you could make someone pregnant, it is important to use effective contraception. You need to do this while you are having venetoclax + cytarabine and for at least 3 months after you stop.
• If you think you might be pregnant, tell your haematology team as soon as possible. They may recommend stopping venetoclax + cytarabine for a while. They could also recommend switching to a different treatment.
• If you are planning to get pregnant, or make someone pregnant, tell your haematology team. They can discuss your treatment options with you.

Breastfeeding

Scientists are not sure if venetoclax + cytarabine passes into breast milk. If it does, it could be a risk for breastfed babies or children. You should not breastfeed when having venetoclax + cytarabine.

Back to top

During your treatment with venetoclax + cytarabine you will have blood tests:

• Before you start treatment
• After each new dose of venetoclax when your dose is being gradually increased
• After reaching your full dose of venetoclax
• Regularly throughout your treatment with cytarabine

You may also have further blood and bone marrow tests during your treatment. Your haematology team will let you know what tests you need and how often.

Your haematology team will use the results of these tests to:

• Check how well venetoclax + cytarabine is working for you
• Make sure your blood counts have not dropped too low
• Check how well your liver and kidneys are working
• Check the level of salts in your blood

Tumour lysis syndrome

Chemotherapy kills cancer cells. When lots of cancer cells breakdown quickly, they can release a large amount of chemicals into your blood. This is known as tumour lysis syndrome. It can affect how well your kidneys work, as well as causing changes to your heartbeat and sometimes fits (seizures).

If you have a very high leukaemia cell count before treatment, your haematology team might give you medicine to help prevent tumour lysis syndrome. They will monitor you closely so they can treat it quickly if it happens.

Back to top

You usually carry on having venetoclax + cytarabine unless:

• It has not worked well enough
• It stops working well
• You are having side effects that are difficult to cope with

If this happens, your haematology team might stop venetoclax + cytarabine, adjust your dose or recommend a different treatment.

Back to top

You may get some side effects while you are having venetoclax + cytarabine. Some people may have very few side effects, whereas other people experience more serious side effects.

Tell your haematology team about any side effects you have. They may be able to suggest things you can do or give you medicines to help.

If you are getting side effects that are difficult to cope with, your haematology team might suggest:

• Temporarily stopping treatment
• Lowering your dose of venetoclax + cytarabine

Back to top

The most common serious side effects for people having venetoclax + cytarabine include:

• A high temperature (higher than 38°C) with a low white blood cell count (febrile neutropenia). You might also feel shivery or generally unwell.
• Pneumonia (a lung infection). You may get symptoms like:
  • A cough, chest pain, shortness of breath, wheezing.
  • A high temperature.
  • An aching body, feeling very tired, loss of appetite.
• Sepsis, which is a life-threatening reaction to an infection. You may get symptoms like:
  • Feeling confused, slurring your words, not making sense.
  • Blue, grey, pale or blotchy skin, lips or tongue. This may look different on black or brown skin.
  • A rash that doesn’t fade when you roll a glass over it.
  • Difficulty breathing, shortness of breath or breathing very fast.

Back to top

Very common side effects affect more than 10 in every 100 people who are having venetoclax + cytarabine. Very common side effects include:

• A low platelet count, which might lead to unexpected bruising or bleeding like nosebleeds, bleeding gums, blood spots or rashes
• A low white blood cell count, which might mean that you get infections more often and any infections you get might last longer than usual
• A low red blood cell count (anaemia), which can make you feel tired, dizzy or short of breath
• Low potassium levels which can cause muscle weakness, muscle cramps and a fast and irregular heartbeat
• Swelling, due to a build up of fluid, in your legs, ankles and feet and sometimes your arms and hands
• Feeling sick or being sick
• Diarrhoea
• Constipation

Cytarabine syndrome

This is a type of allergic reaction that might happen 6 to 12 hours after having a cytarabine injection. You may get symptoms like:

• Fever
• Muscle aches and pains
• Bone pain
• Chest pain
• Reddish skin covered in bumps (this may look different on black or brown skin)
• Red and sore eyes
• Feeling sick
• Feeling generally unwell

If you experience these symptoms, tell your haematology team. They may give you steroids, if you need them.

Back to top

If venetoclax + cytarabine are not working well, your haematology team might suggest altering your treatment cycle, your dose, or stopping treatment if your blood counts drop.

If this is not suitable for you, or does not work, they will talk to you about your treatment options.

Back to top