🛡️ Anti-Infective Prophylaxis in CLL/SLL by Prof Ahmed Absi 🧬 BTK inhibitors (ibrutinib, acalabrutinib, zanubrutinib) • 🚫 No antibacterial • 🚫 No antifungal • 🚫 No PJP • 🚫 No HSV/VZV • 🚫 No CMV 💊 Venetoclax • 🚫 No antibacterial • 🚫 No antifungal • 🚫 No PJP • 🚫 No HSV/VZV • 🚫 No CMV 🧪 Anti-CD20 mAbs (rituximab, ofatumumab, obinutuzumab) • 🚫 No antibacterial • 🚫 No antifungal • 🚫 No PJP • 🚫 No HSV/VZV • 🚫 No CMV 🔥 Duvelisib • 🚫 No antibacterial • 🚫 No antifungal • ✅ PJP prophylaxis required • 🚫 No HSV/VZV • 🔎 CMV monitoring recommended 🧴 Alkylators (chlorambucil) • 🚫 No antibacterial • 🚫 No antifungal • 🚫 No PJP • 🚫 No HSV/VZV • 🚫 No CMV 🧬 Bendamustine • 🚫 No antibacterial • 🚫 No antifungal • 🚫 No PJP • 🚫 No HSV/VZV • 🚫 No CMV 💉 Fludarabine (purine analog monotherapy) • 🚫 No antibacterial • 🚫 No antifungal • ⚠️ PJP (depends on lymphopenia) • ✅ HSV/VZV prophylaxis • 🚫 No CMV 🧬 Purine analog + anti-CD20 • 🚫 No antibacterial • 🚫 No antifungal • ⚠️ PJP sometimes • 🚫 No HSV/VZV • 🚫 No CMV 🟡 Chlorambucil + anti-CD20 • 🚫 No antibacterial • 🚫 No antifungal • 🚫 No PJP • 🚫 No HSV/VZV • 🚫 No CMV 🧪 Purine analog + cyclophosphamide • 🚫 No antibacterial • 🚫 No antifungal • ⚠️ PJP sometimes • 🚫 No HSV/VZV • 🚫 No CMV 🧬 Purine analog + cyclophosphamide + anti-CD20 (FCR-like) • 🚫 No antibacterial • 🚫 No antifungal • ✅ PJP prophylaxis required • 🚫 No HSV/VZV • 🚫 No CMV 🩸 Alemtuzumab • 🚫 No antibacterial • 🚫 No antifungal • ✅ PJP prophylaxis • ✅ HSV/VZV prophylaxis • 🔎 Weekly CMV PCR monitoring #CLL #SLL #HemeFellows #ASH #SOHO #KFSHRC

🔥 Asciminib Safety Advantage vs Other TKIs (Week 96 Data – NEJM 2023) Safety profile ✅ Better than Imatinib and 2nd-gen TKIs (Dasatinib/Nilotinib/Bosutinib) 📊 Grade ≥3 Adverse Events •Asciminib: 44.5% ✅ lowest •Imatinib: 49.5% •2nd-gen TKIs: 59.8% ❌ highest toxicity ⛔ AEs Leading to Discontinuation •Asciminib: 5.0% ✅ best tolerance •Imatinib: 13.1% •2nd-gen TKIs: 12.7% ⚙️ AEs Leading to Dose Interruption •Asciminib: 33% ✅ lowest •Imatinib: 41.4% •2nd-gen TKIs: 57.8% ❌ worst 📉 54% lower risk of discontinuation due to AEs vs 2G TKIs (HR 0.46; 95% CI 0.21–1.02) ✅ Clinical Pearl Asciminib = safer, better tolerated, less treatment interruption → ideal for patients intolerant to prior TKIs. ⸻ ✅ MCQ (Board Style) Which of the following is TRUE regarding asciminib safety? A) Has higher discontinuation rates than nilotinib B) Causes more grade ≥3 AEs than bosutinib C) Has fewer dose interruptions than 2G TKIs D) More QTc prolongation than ponatinib ✅ Correct Answer: C ⸻ 🩺 OSCE Scenario – Treatment Intolerance Case: A 55-year-old with CML-CP failed dasatinib due to recurrent pleural effusions and bosutinib due to diarrhea and liver enzyme elevation. He is anxious about toxicity from another TKI. What do you recommend? Key Answer Points: ✅ Switch to asciminib – best safety profile after ≥2 TKIs ✅ Lower risk of discontinuation vs 2G TKIs ✅ Counsel on monitoring (CBC, lipase/amylase, LFTs) ✅ Emphasize adherence + molecular monitoring ⸻ #CML #Asciminib #STAMP #TKI #Safety #Hematology #ELN2024 #NCCN2025 #HemaFellows #BoardReview #SOHO25