A. FCR B. Bendamustine + rituximab C. Ibrutinib + rituximab D. Ibrutinib

A. Switch to an agent in the same class (e.g., acalabrutinib) B. Add obinutuzumab to ibrutinib therapy C. Switch to venetoclax + rituximab D. Increase ibrutinib dose

A. Hold therapy and attempt another course of corticosteroids B. Switch to a more selective BTKi, such as acalabrutinib C. Reduce ibrutinib dose and recommend ibuprofen prn D. Continue ibrutinib and initiate acetaminophen 650 mg PO Q6H prn

A. Ibrutinib has been used with direct oral anticoagulants (DOACs) or low–molecular-weight heparin (LMWH), but risk of bleeding is increased and the benefits and risks of alternative therapy for CLL should be considered B. Warfarin would be the best choice, as the INR can easily be monitored C. Anticoagulation can safely be discontinued as ibrutinib provides adequate anticoagulation for deep vein thrombosis (DVT) treatment D. Concurrent use of ibrutinib with anticoagulant or antiplatelet agents does not increase risk of a bleeding event

A. The headache is unlikely to improve with continued therapy and alternative treatment is warranted B. Continue acalabrutinib and add supportive care, such as acetaminophen and caffeine, and counsel her that headaches are often transient and resolve within 4–8 weeks C. Reduce dose to 100 mg PO once daily based on package insert dosing D. High-dose NSAID therapy is safest and most effective treatment for acalabrutinib-induced headache