Impact of age and treatment institution type on outcomes of patients treated for chronic lymphocytic leukemia in British Columbia, Canada

Clinical trial participation, clinical care, and patient outcomes by practice setting: a real-world database analysis of patients with Chronic Lymphocytic Leukemia or Mantle Cell Lymphoma

OBJECTIVE

This study was designed to compare treatment patterns, clinical trial participation, and clinical outcomes among patients with small lymphocytic lymphoma/chronic lymphocytic leukemia (CLL) or Mantle cell lymphoma (MCL) by site of care.

METHODS

A nationwide electronic health record (EHR)-derived de-identified database was utilized for this study. Eligible patients were diagnosed with either CLL or MCL from 2013-2022 who received systemic therapy for their disease. Overall survival (OS) was analyzed using Kaplan Meier method, censoring patients without events at last observation in the database. Cox proportional hazards regression model was used to adjust for baseline covariates.

RESULTS

A total of 6,372 patients with CLL and 3,411 with MCL met eligibility criteria for this analysis; 13.9% and 22.2%, respectively, were treated in academic settings. Academic settings were associated with higher patient volume and were more likely to treat MCL with CAR-T, enroll patients with CLL or MCL to clinical trials, and care for patients who were younger, White, and for CLL with higher rates of del(17p) mutations (all p < 0.01). Survival was significantly longer among patients treated in academic vs community settings (median OS not reached vs 80.5 months for CLL; 95.6 vs 68.7 months for MCL from start of first-line therapy).

DISCUSSION

Patients who received care in academic settings differed from those treated in the community; care in academic settings was associated with significantly longer OS and higher trial participation. Further research is warranted to better understand the factors that may contribute to the observed outcomes.

Chronic Lymphocytic Leukemia: Investigation of Survival and Prognostic Factors with Drug-Related Remission

Background/Objectives: Understanding the pathogenesis of chronic lymphocytic leukemia (CLL) has led to the development of new prognostic and diagnostic tools, and efforts are underway to extend survival with new prognostic markers and treatment agents. This study aims to evaluate the factors affecting the prognosis and survival of patients with CLL via a retrospective study. Methods: Accordingly, the demographic features of, clinical and laboratory findings for, and hematological parameters and treatment responses of 178 CLL patients who were followed between 1 January 2015 and 31 December 2024 were analyzed before and after treatment protocols were carried out. Results: During the follow-up period, 40.8% of the patients received medical therapy, with 42.5% achieving complete remission, 49.3% experiencing partial remission, and 8.2% demonstrating no response to the treatments. The results demonstrated that an advanced Binet stage, the presence of splenomegaly, a positive direct Coombs test, the presence of a 17p deletion, thrombocytopenia, and elevated creatinine, leukocyte, and lymphocyte counts were associated with increased mortality. Elevated Binet and Rai stages, the existence of 17p deletion, and reduced hemoglobin levels were identified as statistically significant factors. Conclusions: Given the unfavorable prognosis of CLL patients exhibiting a positive direct Coombs test and compromised renal function, further investigations are required to validate the necessity of more rigorous monitoring and, possibly, early intervention. These findings underscore the importance of identifying high-risk factors in CLL to optimize patient management and improve long-term outcomes.

Treatment patterns in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma post covalent Bruton tyrosine kinase inhibitor treatment: a Japanese claims database study

Standard treatment has not been established for patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) after discontinuation of covalent Bruton tyrosine kinase inhibitor (cBTKi) therapy. This retrospective, administrative database (Medical Data Vision) study described the patient characteristics, treatment patterns, and factors associated with receiving post-first-cBTKi treatment in Japanese patients with CLL/SLL. Patients aged ≥18 years with confirmed CLL/SLL diagnosis and treated with anti-neoplastic drugs indicated for CLL/SLL between March 2013 and February 2022 were included. Patient characteristics at baseline (first line), first cBTKi exposure (first-cBTKi), post-first-cBTKi treatment received, and the treatment sequence of CLL drugs received first line through third line, were described. Time-to-event analyses used the Kaplan-Meier method. Multivariable logistic regression analysis was used to explore factors associated with receiving post-first-cBTKi treatment among patients who discontinued first-cBTKi treatment. Among 2,424 eligible patients (median age: 72.0 years, 61.9% male), 450 (18.6%) received cBTKi in any treatment line. Among patients treated with cBTKi, 273 (60.7%) discontinued treatment; 56.0% of them (n = 153/273) received subsequent treatment. Median duration of post-first-cBTKi treatment was 2.2 months (95% confidence interval [CI]: 1.8, 3.5). The most common regimens post-first-cBTKi were cBTKi therapy (47.7%), bendamustine-based therapy (17.0%), and venetoclax-based therapy (13.1%). Patients aged <75 years (odds ratio [OR] [95% CI]: 2.0 [1.2, 3.4]) and those who did not receive blood transfusion during cBTKi treatment (OR [95% CI]: 2.3 [1.3, 4.1]) were more likely to receive post-first-cBTKi treatment. In conclusion, Japanese patients with CLL/SLL received various treatments for short duration after first-cBTKi discontinuation.