Summary for doctors
- First line in CLL; a fixed 12-month chemotherapy-free treatment [1].
- Venetoclax starts on day 22 of cycle 1 with a 5-week weekly ramp-up [1].
- Before starting venetoclax, assess the tumour lysis risk from node size and lymphocyte count.
- Treatment is started only when iwCLL criteria for active disease are met [2].
Dose and schedule
VenO
Previously untreated CLL (especially with comorbidities or a preference for fixed-duration treatment)Cycle length: Every 28 days
Previously untreated CLL (especially with comorbidities or a preference for fixed-duration treatment)
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Cycle 1 | |||
| Obinutuzumab | 100 mg on day 1 and 900 mg on day 2, then 1000 mg | IV | Days 1 and 2, 8 and 15 |
| Cycles 2 to 6 | |||
| Obinutuzumab | 1000 mg | IV | Day 1 |
| From day 22 of cycle 1 | |||
| Venetoclax (ramp-up) | 20, 50, 100, 200 and 400 mg, one week each | Oral, with food | Daily |
| Until the end of cycle 12 | |||
| Venetoclax | 400 mg | Oral | Daily |
Evidence: CLL14 (2019)
Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.
Premedication and supportive care
- Tumour lysis: low risk (all nodes below 5 cm and lymphocytes below 25,000): oral hydration and allopurinol; medium: more hydration; high (a node of 10 cm or more, or a node of 5 cm or more with lymphocytes of 25,000 or more): admission, IV hydration and rasburicase. Blood tests before the dose and 8 and 24 hours after the 20 and 50 mg doses.
- Obinutuzumab: premedication (steroid, antihistamine, paracetamol); infusion reactions are common with the first dose.
- Before anti-CD20 treatment: HBsAg and anti-HBc [3].
Monitoring and dose adjustment
- Neutropenia is common; weekly blood counts in the first 2 months; G-CSF if needed.
- Reduce the venetoclax dose with azoles (posaconazole is contraindicated during the ramp-up).
- MRD at the end of treatment indicates the prognosis.
Main evidence
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CLL14: 2-year progression-free survival 88.2% with venetoclax-obinutuzumab vs 64.1% with chlorambucil-obinutuzumab; benefit was also seen with TP53 abnormalities and unmutated IGHV [1]. Read more: the best treatment for CLL.
Related cancer types
Treatment regimens (physicians)
Physician tools and lessons
References
5 referencesShow all references, 2 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
- 1
- 2iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL
- 3Hepatitis B Virus Screening and Management for Patients With Cancer Prior to Therapy: ASCO Provisional Clinical Opinion Update
- 4VENCLEXTA (VENETOCLAX) — Prescribing Information
- 5GAZYVA (OBINUTUZUMAB) — Prescribing Information
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
Printed from the website; the full and up-to-date version: https://drdabiri.com/en/regimens/venetoclax-obinutuzumab-cll/