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van der Straten L, Stege CAM, Kersting S, Nasserinejad K, Dubois J, Dobber JA, Mellink CHM, van der Kevie-Kersemaekers AMF, Evers LM, de Boer F, Koene HR, Schreurs J, van der Klift M, Velders GA, van der Spek E, van der Straaten HM, Hoogendoorn M, van Gelder M, Posthuma EFM, Visser HPJ, Houtenbos I, Idink CAM, Issa DE, Dompeling EC, van Zaanen HCT, Veelken JH, Levenga H, Tick LW, Terpstra WE, Tonino SH, Westerweel PE, Langerak AW, Kater AP, Levin MD. Fixed-duration venetoclax plus obinutuzumab improves quality of life and geriatric impairments in FCR-unfit patients with CLL. Blood 2023; 142:1131-1142. [PMID: 37363833 DOI: 10.1182/blood.2023020195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/26/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL)-related symptoms and morbidity related to the advanced age at diagnosis impairs the well-being of older adult patients. Therefore, it is essential to tailor treatment according to geriatric characteristics and aim for an improvement in health-related quality of life (HRQoL) as a primary treatment goal. In the HOVON139/GiVe trial, 12 cycles of fixed-duration venetoclax plus obinutuzumab (Ven-O) were shown to be effective and tolerable in FCR (fludarabine, cyclophosphamide, rituximab)-unfit patients with CLL (n = 67). However, prolonged venetoclax exposure as consolidation treatment led to increased toxicity with limited effect on minimal residual disease. To assess the impact of geriatric assessment on treatment outcomes and the patients' HRQoL, patient-reported outcomes (PROs), including function, depression, cognition, nutrition, physical performance, muscle parameters, comorbidities, and the European Organization for Research and Treatment of Cancer C30 and CLL17 questionnaires were assessed. At baseline, geriatric impairments were present in >90% of patients and ≥2 impairments present in 60% of patients predicted grade ≥3 nonhematological toxicity. During treatment, the number of geriatric impairments diminished significantly and clinically relevant improvements in HRQoL subscales were reached for global health status, physical functioning, role functioning, emotional functioning, fatigue, dyspnea, physical condition or fatigue, and worries or fears related to health and functioning. These improvements were comparable for patients receiving venetoclax consolidation and patients in whom treatment could mostly be discontinued. Collectively, frontline fixed-duration Ven-O improves overall PROs in older, unfit patients with CLL with and without geriatric impairments. This study was registered at EudraCT as 2015-004985-27 and the Netherlands Trial Register as NTR6043.
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Affiliation(s)
- Lina van der Straten
- Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Claudia A M Stege
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam-Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Sabina Kersting
- Department of Hematology, HAGA Teaching Hospital, The Hague, The Netherlands
| | - Kazem Nasserinejad
- Department of Hematology, HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Julie Dubois
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam, The Netherlands
| | - Johan A Dobber
- Department of Laboratory Special Hematology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Clemens H M Mellink
- Department of Human Genetics, Section Cytogenetics, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Ludo M Evers
- Department of Laboratory Special Hematology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Fransien de Boer
- Department of Internal Medicine, Ikazia Hospital, Rotterdam, The Netherlands
| | - Harry R Koene
- Department of Hematology, Antonius Hospital, Nieuwegein, The Netherlands
| | - John Schreurs
- Department of Internal Medicine, Martini Hospital, Groningen, The Netherlands
| | | | - Gerjo A Velders
- Department of Internal Medicine, Gelderland Valley Hospital, Ede, The Netherlands
| | - Ellen van der Spek
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Mels Hoogendoorn
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Michel van Gelder
- Department of Hematology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Eduardus F M Posthuma
- Department of Internal Medicine, Reinier The Graaf Hospital, Delft, The Netherlands
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hein P J Visser
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Ilse Houtenbos
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Cecile A M Idink
- Department of Internal Medicine, ZorgSaam Hospital, Terneuzen, The Netherlands
| | - Djamila E Issa
- Department of Internal Medicine, Jeroen Bosch Hospital, s-Hertogenbosch, The Netherlands
| | | | - Henk C T van Zaanen
- Department of Internal Medicine, St Franciscus Hospital, Rotterdam, The Netherlands
| | - J Hendrik Veelken
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Henriette Levenga
- Department of Internal Medicine, Groene Hart Hospital, Gouda, The Netherlands
| | - Lidwine W Tick
- Department of Internal Medicine, Maxima Medical Center, Eindhoven, The Netherlands
| | - Wim E Terpstra
- Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Sanne H Tonino
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam, The Netherlands
| | - Peter E Westerweel
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Anton W Langerak
- Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - Arnon P Kater
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam, The Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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2
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Oerlemans S, Efficace F, Kieffer JM, Kyriakou C, Xochelli A, Levedahl K, Petranovic D, Borges FC, Bredart A, Shamieh O, Gziskevicius L, Lehmann J, Scholz CW, Caocci G, Molica S, Stamatopoulos K, Panteliadou AK, Papaioannou M, Alrjoob W, Baliakas P, Rosenquist R, Malak S, Miranda A, Cocks K, van de Poll-Franse L. International validation of the EORTC QLQ-CLL17 questionnaire for assessment of health-related quality of life for patients with chronic lymphocytic leukaemia. Br J Haematol 2022; 197:431-441. [PMID: 35255152 DOI: 10.1111/bjh.18072] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 11/26/2022]
Abstract
Selecting the most appropriate chronic lymphocytic leukaemia (CLL) treatment is challenging. Patient-reported health-related quality of life (HRQoL) is therefore a critical aspect to consider. This international study by the European Organization for Research and Treatment of Cancer (EORTC) tested the psychometric properties of a newly developed measure for CLL patients: the EORTC QLQ-CLL17 to supplement the core questionnaire (EORTC QLQ-C30). Patients with CLL (n = 341) from 12 countries completed the QLQ-C30, QLQ-CLL17 and a debriefing questionnaire. Sociodemographic and clinical data were recorded from medical records. A high percentage (30%-66%) reported symptoms and/or worries (e.g. aches/pains in muscles, lack of energy and worry/fears about health). Confirmatory factor analysis showed an acceptable to good fit of the 17 items on the three scales (i.e. symptom burden, physical condition/fatigue and worries/fears about health and functioning). Completion took on average 8 min. Test-retest and convergent validity was demonstrated. The QLQ-CLL17 differentiated between patients with an Eastern Cooperative Oncology group (ECOG) performance of 0 versus 1-3 (p's < 0.01 and clinically relevant). The newly developed EORTC QLQ-CLL17 will increase sensitivity of HRQoL assessment in patients with CLL. Implementation of this questionnaire both in clinical research and practice will help to generate unique clinically relevant data to better inform CLL treatment decision-making.
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Affiliation(s)
- Simone Oerlemans
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA) Data Centre, Rome, Italy
| | - Jacobien M Kieffer
- Department of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Aliki Xochelli
- Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece
| | - Kerstin Levedahl
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Duska Petranovic
- Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia
| | - Fabio Cardoso Borges
- Department of Epidemiology and National Cancer Registry (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E, Lisbon, Portugal
| | - Anne Bredart
- Institut Curie - Psycho-Oncology Unit, Paris University, Paris, France.,Psychopathology and Health Process Laboratory (LPPS) (UR 4057), PSL University, Paris, France
| | - Omar Shamieh
- Department of Palliative Medicine, King Hussein Cancer Center, Amman, Jordan
| | | | - Jens Lehmann
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Giovanni Caocci
- Hematology, Businco Hospital, University of Cagliari, Cagliari, Italy
| | | | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece
| | | | - Maria Papaioannou
- Hematology Unit, 1st Dept of Internal Medicine, AUTH, AHEPA Hospital, Thessaloniki, Greece
| | - Waleed Alrjoob
- Department of Palliative Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Panagiotis Baliakas
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra Malak
- Hôpital René Huguenin-Institut Curie - Hématologie, Saint-Cloud, France
| | - Ana Miranda
- Department of Epidemiology and National Cancer Registry (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E, Lisbon, Portugal
| | - Kim Cocks
- York Trials Unit, University of York, York & Adelphi Values, Cheshire, UK
| | - Lonneke van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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3
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Ishdorj G, Nugent Z, Squires M, Kost S, Banerji V, Davidson L, Katyal CS, Marshall A, Gibson SB, Johnston JB. Rapid improvement in symptoms and physical function following ibrutinib initiation in chronic lymphocytic leukemia and the associated changes in plasma cytokines. Leuk Res 2021; 109:106628. [PMID: 34134067 DOI: 10.1016/j.leukres.2021.106628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/03/2021] [Accepted: 05/23/2021] [Indexed: 11/23/2022]
Abstract
A prospective pilot study was carried out on 34 CLL patients treated with ibrutinib, evaluating the effects on symptoms and physical function with changes in plasma exosomes (EXs), β2-microglobulin (β2M) and 26 plasma cytokines. The revised Edmonton Symptom Assessment Scale (ESAS-R) demonstrated moderate fatigue, shortness of breath and a sense of unwellness before treatment, which significantly improved within 2 weeks of starting ibrutinib. These changes were associated with a rapid improvement in sit-to-stand and 4 m walking speeds. The plasma levels of CCL11, IL-7, -8 and -10 dropped initially while the levels of TNF-α/-β, CCL3, CCL4, CCL17, and IL-16 continued to decline for 12 months. Despite the initial lymphocytosis, plasma β2M levels fell but no consistent change in plasma EXs occurred. Thus, ibrutinib can produce a rapid and sustained improvement in symptoms and physical function in CLL, associated with a decline in multiple plasma cytokines.
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4
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Sharman JP, Cocks K, Nabhan C, Lamanna N, Kay NE, Grinblatt DL, Flowers CR, Davids MS, Kiselev P, Swern AS, Sullivan K, Gharibo MM, Flick ED, Trigg A, Mato A. Longitudinal health-related quality of life in first-line treated patients with chronic lymphocytic leukemia: Results from the Connect ® CLL Registry. EJHaem 2020; 1:188-198. [PMID: 35847738 PMCID: PMC9176138 DOI: 10.1002/jha2.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 06/15/2023]
Abstract
Health-related quality of life (HRQoL) in patients with chronic lymphocytic leukemia (CLL) is important in guiding treatment decisions. However, the impact of CLL treatment initiation on HRQoL is unclear. We assessed HRQoL using the FACT-Leu and EQ-5D-3L questionnaires in the Connect ® CLL Registry, a large, US-based, multicenter, prospective observational study of CLL patients enrolled between 2010 and 2014, prior to the introduction of novel therapies. Among 889 patients initiating first-line therapy with chemoimmunotherapy or rituximab monotherapy, questionnaire completion rates were 95.7% and 95.8% at enrollment, and 70.8% and 69.4% at 12 months, for FACT-Leu Total and EQ-5D-3L, respectively. For 849 patients completing all five FACT-Leu components, average total scores were 135.7 at enrollment and 141.6 at 12 months. Among 526 patients with FACT-Leu Total scores at enrollment and 12 months, clinically meaningful (≥11-point) improvements or reductions were observed in 179 (34.0%) and 88 (16.7%) patients, respectively. Mean EQ-5D-3L index scores were 0.87 at enrollment and 12 months. Among 513 patients completing EQ-5D-3L at enrollment and 12 months, clinically meaningful (≥0.06-point) improvements or reductions were observed in 125 (24.4%) and 116 (22.6%) patients, respectively. In the Connect® CLL Registry, HRQoL remained stable or slightly improved after 12 months of follow-up.
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Affiliation(s)
- Jeff P. Sharman
- Willamette Valley Cancer InstituteUS OncologyEugeneOregonUSA
| | | | - Chadi Nabhan
- Caris Life SciencesDallasTexasUSA
- University of South CarolinaColumbiaSouth CarolinaUSA
| | - Nicole Lamanna
- Division of Hematology and OncologyDepartment of MedicineNew York‐Presbyterian/Columbia University Medical CenterNew YorkNew YorkUSA
| | - Neil E. Kay
- Division of HematologyMayo ClinicRochesterMinnesotaUSA
| | | | | | - Matthew S. Davids
- Department of Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | | | | | | | | | | | | | - Anthony Mato
- Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
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5
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Woyach JA, Blachly JS, Rogers KA, Bhat SA, Jianfar M, Lozanski G, Weiss DM, Andersen BL, Gulrajani M, Frigault MM, Hamdy A, Izumi R, Munugalavadla V, Quah C, Wang MH, Byrd JC. Acalabrutinib plus Obinutuzumab in Treatment-Naïve and Relapsed/Refractory Chronic Lymphocytic Leukemia. Cancer Discov 2020; 10:394-405. [PMID: 31915195 DOI: 10.1158/2159-8290.cd-19-1130] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/05/2019] [Accepted: 01/02/2020] [Indexed: 11/16/2022]
Abstract
Acalabrutinib is a selective irreversible Bruton tyrosine kinase (BTK) inhibitor that does not affect IL2-associated tyrosine kinase or antibody-dependent cellular cytotoxicity, making it an attractive candidate for combination therapy with anti-CD20 antibodies. We investigated acalabrutinib plus obinutuzumab in a phase Ib/II study (NCT02296918) of patients with treatment-naïve or relapsed/refractory chronic lymphocytic leukemia (CLL). Nineteen treatment-naïve and 26 relapsed/refractory patients were treated with acalabrutinib (100 mg twice daily) until progression and obinutuzumab (cycle 1: 100 mg day 1, 900 mg day 2, 1000 mg days 8 and 15; cycles 2-6: 1,000 mg day 1). Grade 3/4 adverse events occurred in 71% of patients. Overall response rates were 95% (treatment-naïve) and 92% (relapsed/refractory). Thirty-two percent of treatment-naïve and 8% of relapsed/refractory patients achieved complete remission. At 36 months, 94% (treatment-naïve) and 88% (relapsed/refractory) were progression free. Acalabrutinib plus obinutuzumab was well tolerated, producing high and durable responses in treatment-naïve and relapsed/refractory CLL. SIGNIFICANCE: Rituximab plus the less selective BTK inhibitor ibrutinib has not shown benefit in CLL; however, the selective BTK inhibitor acalabrutinib plus the antibody-dependent cellular cytotoxicity-enhanced antibody obinutuzumab yielded durable responses that deepened over time in treatment-naïve and relapsed/refractory CLL, supporting the evaluation of this approach in larger, comparative studies in CLL.This article is highlighted in the In This Issue feature, p. 327.
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MESH Headings
- Adult
- Agammaglobulinaemia Tyrosine Kinase/antagonists & inhibitors
- Agammaglobulinaemia Tyrosine Kinase/genetics
- Aged
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Benzamides/administration & dosage
- Benzamides/adverse effects
- Cell Proliferation/drug effects
- Drug Administration Schedule
- Female
- Humans
- Interleukin-2/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Middle Aged
- Pyrazines/administration & dosage
- Pyrazines/adverse effects
- Rituximab/administration & dosage
- Treatment Outcome
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Affiliation(s)
- Jennifer A Woyach
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
| | - James S Blachly
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Kerry A Rogers
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Seema A Bhat
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Mojgan Jianfar
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Gerard Lozanski
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - David M Weiss
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | | | - Michael Gulrajani
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, California
| | - Melanie M Frigault
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, California
| | - Ahmed Hamdy
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, California
| | - Raquel Izumi
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, California
| | | | - Cheng Quah
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, California
| | - Min-Hui Wang
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, California
| | - John C Byrd
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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Montillo M, Illés Á, Robak T, Pristupa AS, Wach M, Egyed M, Delgado J, Jurczak W, Morschhauser F, Schuh A, Eradat H, Shreay S, Barrientos JC, Zelenetz AD. Idelalisib addition has neutral to beneficial effects on quality of life in bendamustine/rituximab-treated patients: results of a phase 3, randomized, controlled trial. Health Qual Life Outcomes 2019; 17:173. [PMID: 31729982 PMCID: PMC6858733 DOI: 10.1186/s12955-019-1232-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/11/2019] [Indexed: 11/11/2022] Open
Abstract
Background In a phase 3 randomized, double-blind, placebo-controlled trial, treatment with idelalisib, a phosphoinositol-3 kinase δ inhibitor, + bendamustine/rituximab improved progression-free survival (PFS) and overall survival (OS) in adult patients with relapsed/refractory chronic lymphocytic leukemia (R/R CLL). Here we report the results of health-related quality of life (HRQL) analyses from this study. Methods From June 15, 2012 to August 21, 2014, 416 patients with R/R CLL were enrolled; 207 patients were randomized to the idelalisib arm and 209 to the placebo arm. In the 416 patients randomized to receive bendamustine/rituximab and either oral idelalisib 150 mg twice-daily or placebo, HRQL was assessed at baseline and throughout the blinded part of the study using the Functional Assessment of Cancer Therapy–Leukemia (FACT-Leu) and EuroQoL Five-Dimension (EQ-5D) visual analogue scale (VAS) questionnaires. The assessments were performed at scheduled patient visits; every 4 weeks for the first 6 months from the initiation of treatment, then every 8 weeks for the next 6 months, and every 12 weeks thereafter until end of study. Least-squares mean changes from baseline were estimated using a mixed-effects model by including treatment, time, and treatment-by-time interaction, and stratification factors as fixed effects. Time to first symptom improvement was assessed by Kaplan-Meier analysis. Results In mixed-effects model analysis, idelalisib + bendamustine/rituximab treatment led to clinically meaningful improvements from baseline in leukemia-associated symptoms. Moreover, per Kaplan-Meier analysis, the proportion of patients with symptom improvement was higher and time to improvement was shorter among patients in the idelalisib-containing arm compared with those who did not receive idelalisib. The physical and social/family FACT-Leu subscale scores, along with the self-rated health assessed by EQ-VAS, showed improvement with idelalisib over placebo, but the difference did not reach statistical significance. The functional and emotional FACT-Leu subscale scores remained similar to placebo. Conclusions Addition of idelalisib to bendamustine/rituximab, apart from improving PFS and OS, had a neutral to beneficial impact on HRQL in patients with R/R CLL, particularly by reducing leukemia-specific disease symptoms. Trial registration Clinicaltrials.gov NCT01569295. Registered April 3, 2012.
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Affiliation(s)
- Marco Montillo
- Department of Hematology, Niguarda Cancer Center, Niguarda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
| | - Árpád Illés
- Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland
| | | | - Malgorzata Wach
- Department Hemato-Oncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Miklós Egyed
- Department of Hematology, Somogy County Kaposi Mor Hospital, Kaposvar, Hungary
| | - Julio Delgado
- Department of Hematology, Hospital Clínic, Barcelona, Spain
| | | | - Franck Morschhauser
- CHRU Lille, Unité GRITA, Department of Hematology, Université de Lille, Lille, France
| | - Anna Schuh
- University of Oxford, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford, UK
| | - Herbert Eradat
- Division of Hematology-Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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7
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Goyal NG, Maddocks KJ, Johnson AJ, Byrd JC, Westbrook TD, Andersen BL. Cancer-Specific Stress and Trajectories of Psychological and Physical Functioning in Patients With Relapsed/Refractory Chronic Lymphocytic Leukemia. Ann Behav Med 2019; 52:287-298. [PMID: 30084895 DOI: 10.1093/abm/kax004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Chronic lymphocytic leukemia is the most prevalent adult leukemia. The disease is incurable with a cycling of treatment and relapse common. Little is known about the psychological and physical functioning of patients with relapsed/refractory chronic lymphocytic leukemia. Cancer-specific stress is an important individual difference variable that predicts psychological and physical outcomes. Purpose To examine cancer-specific stress at treatment initiation as a predictor of psychological and physical functioning trajectories in patients with relapsed/refractory chronic lymphocytic leukemia during the first 5 months of treatment. Methods Patients with relapsed/refractory chronic lymphocytic leukemia (N = 152) enrolled in a phase II clinical trial completed self-report measures at treatment initiation (baseline), 1, 2, and 5 months of treatment. Cancer-specific stress at baseline was examined as a predictor of psychological (cognitive-affective depressive symptoms, negative mood, mental health quality of life) and physical functioning (fatigue interference, sleep problems, physical health quality of life), controlling for demographic and treatment variables. Results Using multilevel modeling, higher baseline cancer-specific stress was related to worse psychological (cognitive-affective depressive symptoms, negative mood, mental health quality of life) and physical functioning (fatigue interference, sleep problems) at baseline and more rapid improvements during the next 5 months. Despite these improvements, higher baseline cancer-specific stress remained associated with poorer 5-month psychological, though not physical, functioning. Conclusions Findings suggest cancer-specific stress at treatment initiation may be a risk factor for poorer psychological functioning during treatment for patients with relapsed/refractory chronic lymphocytic leukemia.
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Affiliation(s)
- Neha G Goyal
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC
| | - Kami J Maddocks
- Division of Hematology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH
| | - Amy J Johnson
- Division of Hematology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH
| | - John C Byrd
- Division of Hematology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH
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8
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Barrientos JC, O'Brien S, Brown JR, Kay NE, Reddy NM, Coutre S, Tam C, Mulligan S, Jaeger U, Devereux S, Pocock C, Robak T, Schuster SJ, Schuh A, Gill D, Bloor A, Dearden C, Moreno C, Cull G, Hamblin M, Jones JA, Eckert K, Solman IG, Suzuki S, Hsu E, James DF, Byrd JC, Hillmen P. Improvement in Parameters of Hematologic and Immunologic Function and Patient Well-being in the Phase III RESONATE Study of Ibrutinib Versus Ofatumumab in Patients With Previously Treated Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. Clin Lymphoma Myeloma Leuk 2018; 18:803-813.e7. [PMID: 30249389 DOI: 10.1016/j.clml.2018.08.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/01/2018] [Accepted: 08/06/2018] [Indexed: 01/31/2023]
Abstract
In the phase III study RESONATE, ibrutinib reduced the risk of progression and improved overall survival versus ofatumumab in previously treated patients with CLL/SLL. In this novel analysis of patient well-being including patient-reported outcomes, ibrutinib reduced disease burden while preserving parameters of hematologic and immunologic function in RESONATE. These results suggest that ibrutinib can improve quality of life while prolonging survival.
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9
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Hallek M, Cheson BD, Catovsky D, Caligaris-Cappio F, Dighiero G, Döhner H, Hillmen P, Keating M, Montserrat E, Chiorazzi N, Stilgenbauer S, Rai KR, Byrd JC, Eichhorst B, O'Brien S, Robak T, Seymour JF, Kipps TJ. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood 2018; 131:2745-60. [PMID: 29540348 DOI: 10.1182/blood-2017-09-806398] [Citation(s) in RCA: 901] [Impact Index Per Article: 150.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The previous edition of the consensus guidelines of the International Workshop on Chronic Lymphocytic Leukemia (iwCLL), published in 2008, has found broad acceptance by physicians and investigators caring for patients with CLL. Recent advances including the discovery of the genomic landscape of the disease, the development of genetic tests with prognostic relevance, and the detection of minimal residual disease (MRD), coupled with the increased availability of novel targeted agents with impressive efficacy, prompted an international panel to provide updated evidence- and expert opinion-based recommendations. These recommendations include a revised version of the iwCLL response criteria, an update on the use of MRD status for clinical evaluation, and recommendations regarding the assessment and prophylaxis of viral diseases during management of CLL.
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10
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Robak T, Warzocha K, Govind Babu K, Kulyaba Y, Kuliczkowski K, Abdulkadyrov K, Loscertales J, Kryachok I, Kłoczko J, Rekhtman G, Homenda W, Błoński JZ, McKeown A, Chang CN, Bal V, Lisby S, Gupta IV, Grosicki S. Health-related quality of life and patient-reported outcomes of ofatumumab plus fludarabine and cyclophosphamide versus fludarabine and cyclophosphamide in the COMPLEMENT 2 trial of patients with relapsed CLL. Leuk Lymphoma 2016; 58:1598-1606. [DOI: 10.1080/10428194.2016.1253837] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Tadeusz Robak
- Department of Hematology, Medical University of Łódź, Copernicus Memorial Hospital, Łódź, Poland
| | - Krzysztof Warzocha
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - K. Govind Babu
- Kidwai Memorial Institute of Oncology, Bangalore, India
- HCG Curie Centre of Oncology, Bangalore, India
| | - Yaroslav Kulyaba
- Makiivka City Hospital No. 2 of Donetsk Region, Makiivka, Ukraine
| | | | - Kudrat Abdulkadyrov
- Russian Research Institute of Hematology and Transfusiology, St. Petersburg, Russian Federation
| | | | - Iryna Kryachok
- Oncohematology Department, National Cancer Institute, Kiev, Ukraine
| | | | | | - Wojciech Homenda
- Department of Hematology, Janusz Korczak Hospital, Słupsk, Poland
| | - Jerzy Z. Błoński
- Department of Hematology, Medical University of Łódź, Copernicus Memorial Hospital, Łódź, Poland
| | - Astrid McKeown
- Novartis Pharmaceuticals Corporation, Uxbridge, United Kingdom
| | - Chai-Ni Chang
- Novartis Pharmaceuticals Corporation, Research Triangle Park, NC, USA
| | - Vasudha Bal
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Ira V. Gupta
- Novartis Pharmaceuticals Corporation, King of Prussia, PA, USA
| | - Sebastian Grosicki
- Department of Cancer Prevention, Faculty of Public Health, Medical University of Silesia, Katowice, Poland
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11
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Hillmen P, Janssens A, Babu KG, Kloczko J, Grosicki S, Manson S, McKeown A, Gupta I, Chang CN, Offner F. Health-related quality of life and patient-reported outcomes of ofatumumab plus chlorambucil versus chlorambucil monotherapy in the COMPLEMENT 1 trial of patients with previously untreated CLL. Acta Oncol 2016; 55:1115-1120. [PMID: 27494089 DOI: 10.1080/0284186x.2016.1205217] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients diagnosed with chronic lymphocytic leukemia (CLL) are usually elderly and frequently have a number of comorbidities. Health-related quality of life (HRQoL) for these patients is of utmost importance and should be taken into consideration when assessing new treatment options. The combination of ofatumumab with chlorambucil has shown longer progression-free survival compared with chlorambucil alone. In this study, we aim to assess how this treatment combination affects patients' health-related quality of life and patient-reported symptoms. MATERIAL AND METHODS In this open-label phase III trial, patients with previously untreated CLL for whom fludarabine-based treatment was contra-indicated, were randomized 1:1 to receive oral chlorambucil (10 mg/m2) on Days 1-7 of a 28-day treatment cycle or to receive chlorambucil by this schedule plus intravenous ofatumumab (Cycle 1: 300 mg on Day 1 and 1000 mg on Day 8; subsequent cycles: 1000 mg Day 1) for 3-12 cycles. The EORTC QLQ-C30 and QLQ-CLL16 questionnaires were administered to patients before and during treatment, in follow-up and at the time of disease progression. The primary specified patient-reported outcomes were HRQoL and fatigue. RESULTS Patient-reported improvements from baseline in Global Health Status (GHS)/HRQoL scores and fatigue scores were recorded during treatment with both chlorambucil monotherapy and ofatumumab in combination with chlorambucil. There were no significant differences between the two treatment arms for GHS/HRQoL (p = 0.667) or fatigue (p = 0.103). Following treatment, numerical improvements to GHS/HRQoL and fatigue scores were reported, with no significant differences between the two treatment arms. CONCLUSION Small but detectable improvements in patients' quality of life were reported as a result of treatment. The addition of ofatumumab to chlorambucil did not negatively impact HRQoL. Quality of life was maintained in the months following treatment.
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Affiliation(s)
- Peter Hillmen
- St James’s Institute of Oncology, Leeds, West Yorkshire, UK
| | - Ann Janssens
- Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - K. Govind Babu
- HCG Curie Centre of Oncology, Bangalore, India
- Kidwai Memorial Hospital, Bangalore, Karnataka, India
| | | | - Sebastian Grosicki
- Department of Cancer Prevention, School of Public Health, Silesian Medical University, Katowice, Poland
| | | | | | - Ira Gupta
- Novartis Pharmaceuticals, King of Prussia, PA, USA
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12
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Morrison EJ, Flynn JM, Jones J, Byrd JC, Andersen BL. Individual differences in physical symptom burden and psychological responses in individuals with chronic lymphocytic leukemia. Ann Hematol 2016; 95:1989-1997. [PMID: 27539615 DOI: 10.1007/s00277-016-2790-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 08/06/2016] [Indexed: 10/21/2022]
Abstract
Chronic lymphocytic leukemia (CLL) is an incurable illness, with some patients requiring no treatment until disease progression. Burden from physical symptoms has been associated with depression, anxiety, and stress in cancer patients. Additionally, patient factors, i.e., individual differences, have been associated with worse psychological outcomes. There are few psychological studies of CLL, with no examination of individual differences. A cross-sectional design studied the covariation of symptom burden with depressive and anxiety symptoms and cancer-specific stress, and tested patients' individual differences as predictors and as moderators. CLL patients (N = 112) receiving active surveillance participated. They were Caucasian (100 %) and predominately male (55 %) with a mean age of 61; most (62.5 %) had stage 0 disease. A composite measure of physical symptom burden (CLL symptoms, fatigue, pain, impaired functional status) was tested as a predictor of psychological responses. Individual differences in psychiatric history and social support were tested as moderators. Using multiple linear regression, greater symptom burden covaried with higher levels of depressive and anxiety symptoms and cancer stress (ps < .05). Those with a psychiatric history, low social support, and low relationship satisfaction with one's partner reported greater symptom burden and more psychological symptoms and stress (ps < .05). Findings suggest that CLL patients in surveillance with a psychiatric history and/or low social support are at risk for greater distress when coping with high symptom burden. These new data clarify the experience of CLL surveillance and identify characteristics of patients with heightened risk for symptom burden, stress, and anxiety or depressive symptoms.
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Affiliation(s)
- Eleshia J Morrison
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Joseph M Flynn
- Norton Cancer Institute, 234 E Gray St, Louisville, KY, 40202, USA
| | - Jeffrey Jones
- Division of Hematology, The Ohio State University, Starling Loving Hall, 320 W 10th Avenue, Columbus, OH, 43210, USA
| | - John C Byrd
- Division of Hematology, The Ohio State University, Starling Loving Hall, 320 W 10th Avenue, Columbus, OH, 43210, USA
| | - Barbara L Andersen
- Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH, 43210, USA
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Kutsch N, Busch R, Bahlo J, Mayer J, Hensel M, Hopfinger G, Hess G, von Grünhagen U, Wendtner CM, Maria Fink A, Fischer K, Hallek M, Eichhorst B. FCR front-line therapy and quality of life in patients with chronic lymphocytic leukemia. Leuk Lymphoma 2016; 58:399-407. [PMID: 27357445 DOI: 10.1080/10428194.2016.1190966] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The chemoimmunotherapy FCR (fludarabine and cyclophosphamide with rituximab) is the standard first-line treatment for physically fit chronic lymphocytic leukemia (CLL) patients. To assess the risks and benefits, we investigated health-related quality of life (HRQOL). 817 untreated CLL patients received either FC or FCR within the GCLLSG CLL8 trial. The European Organization for Research and Treatment of Cancer Quality of life Questionnaire C30 was sent to all patients at baseline, after 3, 6, and 12 months and then yearly as follow-up. A total of 769 (94%) of 817 patients completed at least one questionnaire. Comparing HRQOL of CLL patients with the general German population, CLL patients' health declined in most scales except for global health and pain. No major differences in HRQOL were found during treatment or follow-up between both treatment arms. Females were more likely to have treatment-related symptoms than males. Although FCR was associated with more side effects, this did not influence HRQOL. During follow-up after FCR only minor improvement of HRQOL compared with FC was assessed.
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Affiliation(s)
- Nadine Kutsch
- a Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn , University Hospital of Cologne , Cologne , Germany
| | - Raymonde Busch
- b Institute of Medical Statistics and Epidemiology , Technical University , Munich , Germany
| | - Jasmin Bahlo
- a Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn , University Hospital of Cologne , Cologne , Germany
| | - Jiri Mayer
- c Department of Internal Medicine, Hematology and Oncology , University Hospital Brno , Brno , Czech Republic
| | - Manfred Hensel
- d Internal Medicine V , University of Heidelberg , Heidelberg , Germany
| | - Georg Hopfinger
- e Department of Internal Medicine I, Vienna General Hospital, Medical University of Vienna , Vienna , Austria
| | - Georg Hess
- f Department of Hematology and Oncology , Johannes Gutenberg-Universitat , Mainz , Germany
| | | | - Clemens-Martin Wendtner
- a Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn , University Hospital of Cologne , Cologne , Germany.,h Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine , Klinikum Schwabing , Munich , Germany
| | - Anna Maria Fink
- a Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn , University Hospital of Cologne , Cologne , Germany
| | - Kirsten Fischer
- a Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn , University Hospital of Cologne , Cologne , Germany
| | - Michael Hallek
- a Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn , University Hospital of Cologne , Cologne , Germany
| | - Barbara Eichhorst
- a Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn , University Hospital of Cologne , Cologne , Germany
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14
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Frey S, Blankart CR, Stargardt T. Economic Burden and Quality-of-Life Effects of Chronic Lymphocytic Leukemia: A Systematic Review of the Literature. Pharmacoeconomics 2016; 34:479-98. [PMID: 26739956 DOI: 10.1007/s40273-015-0367-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) is the most prevalent type of leukemia in the Western hemisphere. The disease affects quality of life (QOL) and poses an economic burden on patients, payers, and society. The objective of this review was to quantify the economic burden and quality-of-life effects and identify the gaps that should be addressed by future research. METHODS Free-text and subject heading searches in MEDLINE, EMBASE, the Cochrane Library, the University of York Centre for Reviews and Dissemination Database, and the Web of Science Core Collection database were conducted to identify observational and interventional studies reporting costs and/or quality-of-life effects published up to 2 October 2015. Studies were included irrespective of whether they were conducted prospectively or retrospectively. The focus population consisted of adult patients aged 18 years or older affected by any stage of CLL. Studies were included regardless of whether the underlying population was treated at baseline or not. Risk of bias was assessed using a quality checklist developed by the Effective Public Health Practice Project for (randomized) controlled trials, cohort studies, and cross-sectional studies. Economic evaluations were rated using a checklist developed by Stuhldreher et al. (Int J Eat Disord 45:476-91, 2012). RESULTS From 2451 records identified, 27 studies were found to be eligible for inclusion. Studies were heterogeneous with respect to methodology, perspective, and data used. Annual direct costs per person ranged from US$4491 in Germany to US$43,913 in the USA. The share of costs attributable to drug treatment varied between 26.2 and 79 %. Indirect costs amounted to US$4208. Severity of disease was a predictor for quality of life, whereas differences by age and sex were mainly present in subdomains. Comparisons of treated and untreated populations resulted in an increase of quality of life in favor of treated populations in the long-term perspective. Differences between treatments were small. Consequently, cost effectiveness in decision-analytic models did not depend on whether quality of life or survival are used to describe the benefits of treatment. CONCLUSIONS Although the quantity and the quality of health economic and quality-of-life evidence have substantially increased, there is still a need for studies that take a patient or societal perspective. Factors that influence costs and the quality of life of patients seem to be well-established, while longitudinal lifetime cost studies at the population level are still scarce.
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Affiliation(s)
- Simon Frey
- Hamburg Center for Health Economics, Universität Hamburg, Esplanade 36, 20354, Hamburg, Germany
| | - Carl R Blankart
- Hamburg Center for Health Economics, Universität Hamburg, Esplanade 36, 20354, Hamburg, Germany
- Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, RI, USA
| | - Tom Stargardt
- Hamburg Center for Health Economics, Universität Hamburg, Esplanade 36, 20354, Hamburg, Germany.
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15
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Soini E, Hautala A, Poikonen E, Becker U, Kyttälä M, Martikainen J. Cost-effectiveness of First-line Chronic Lymphocytic Leukemia Treatments When Full-dose Fludarabine Is Unsuitable. Clin Ther 2016; 38:889-904.e14. [DOI: 10.1016/j.clinthera.2016.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/31/2016] [Accepted: 02/03/2016] [Indexed: 01/09/2023]
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16
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Cannella L, Caocci G, Jacobs M, Vignetti M, Mandelli F, Efficace F. Health-related quality of life and symptom assessment in randomized controlled trials of patients with leukemia and myelodysplastic syndromes: What have we learned? Crit Rev Oncol Hematol 2015; 96:542-54. [PMID: 26324461 DOI: 10.1016/j.critrevonc.2015.07.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 06/10/2015] [Accepted: 07/28/2015] [Indexed: 01/26/2023] Open
Abstract
Health-related quality of life (HRQOL) and other patient-reported outcomes (PROs) are crucial for a comprehensive evaluation of treatment effectiveness. A systematic review of randomized controlled trials (RCTs) with a PRO endpoint conducted in patients with leukemia and myelodysplastic syndromes (MDS) was performed. Eligible studies were evaluated independently, according to a pre-defined coding scheme, by two reviewers. Thirteen RCTs, enrolling overall 3380 patients were identified. There were four RCTs involving acute myeloid leukemia patients (AML), one with acute lymphoid leukemia (ALL), five with chronic lymphocytic leukemia (CLL) and three with MDS. Six RCTs accurately documented PRO methodology assessment and were thus considered likely to robustly inform clinical decision-making. Of these, three RCTs dealt with AML, two with CLL, one with MDS. A growing number of RCTs in leukemia and MDS have included a PRO component in recent years. Inclusion of PROs in RCTs is feasible and can provide unique information to facilitate clinical decision-making.
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Affiliation(s)
- Laura Cannella
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Giovanni Caocci
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Marc Jacobs
- Academic Medical Center, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - Marco Vignetti
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Franco Mandelli
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy.
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17
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Holtzer-Goor KM, Schaafsma MR, Joosten P, Posthuma EFM, Wittebol S, Huijgens PC, Mattijssen EJM, Vreugdenhil G, Visser H, Peters WG, Erjavec Z, Wijermans PW, Daenen SMGJ, van der Hem KG, van Oers MHJ, Uyl-de Groot CA. Quality of life of patients with chronic lymphocytic leukaemia in the Netherlands: results of a longitudinal multicentre study. Qual Life Res 2015. [PMID: 26205768 PMCID: PMC4615661 DOI: 10.1007/s11136-015-1039-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose To describe the health-related quality of life (HRQoL) of an unselected population of patients with chronic lymphocytic leukaemia (CLL) including untreated patients. Methods HRQoL was measured by the EORTC QLQ-C30 including the CLL16 module, EQ-5D, and VAS in an observational study over multiple years. All HRQoL measurements per patient were connected and analysed using area under the curve analysis over the entire study duration. The total patient group was compared with the general population, and three groups of CLL patients were described separately, i.e. patients without any active treatment (“watch and wait”), chlorambucil treatment only, and patients with other treatment(s). Results HRQoL in the total group of CLL patients was compromised when compared with age- and gender-matched norm scores of the general population. CLL patients scored statistically worse on the VAS and utility score of the EQ-5D, all functioning scales of the EORTC QLQ-C30, and the symptoms of fatigue, dyspnoea, sleeping disturbance, appetite loss, and financial difficulties. In untreated patients, the HRQoL was slightly reduced. In all treatment stages, HRQoL was compromised considerably. Patients treated with chlorambucil only scored worse on the EORTC QLQ-C30 than patients who were treated with other treatments with regard to emotional functioning, cognitive functioning, bruises, uncomfortable stomach, and apathy. Conclusions CLL patients differ most from the general population on role functioning, fatigue, concerns about future health, and having not enough energy. Once treatment is indicated, HRQoL becomes considerably compromised. This applies to all treatments, including chlorambucil, which is considered to be a mild treatment. Electronic supplementary material The online version of this article (doi:10.1007/s11136-015-1039-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K M Holtzer-Goor
- Department of Health Policy and Management, Erasmus University Rotterdam, Institute for Medical Technology Assessment, P.O. Box 1738, 3000DR, Rotterdam, The Netherlands.
| | | | - P Joosten
- Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - E F M Posthuma
- Leiden University Medical Center, Leiden, The Netherlands.,Reinier de Graaf Groep, Delft, The Netherlands
| | - S Wittebol
- Meander Medisch Centrum, Amersfoort, The Netherlands
| | - P C Huijgens
- VU University Medical Center, Amsterdam, The Netherlands
| | | | - G Vreugdenhil
- Máxima Medisch Centrum, Veldhoven, The Netherlands.,MUMC+, Maastricht, The Netherlands
| | - H Visser
- Medisch Centrum Alkmaar, Alkmaar, The Netherlands
| | - W G Peters
- Catharina-ziekenhuis, Eindhoven, The Netherlands
| | - Z Erjavec
- Ommelander Ziekenhuis Groep, Delfzijl, The Netherlands
| | | | - S M G J Daenen
- UMCG, University of Groningen, Groningen, The Netherlands
| | | | - M H J van Oers
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - C A Uyl-de Groot
- Department of Health Policy and Management, Erasmus University Rotterdam, Institute for Medical Technology Assessment, P.O. Box 1738, 3000DR, Rotterdam, The Netherlands
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18
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Burger JA, Keating MJ, Wierda WG, Hartmann E, Hoellenriegel J, Rosin NY, de Weerdt I, Jeyakumar G, Ferrajoli A, Cardenas-Turanzas M, Lerner S, Jorgensen JL, Nogueras-González GM, Zacharian G, Huang X, Kantarjian H, Garg N, Rosenwald A, O'Brien S. Safety and activity of ibrutinib plus rituximab for patients with high-risk chronic lymphocytic leukaemia: a single-arm, phase 2 study. Lancet Oncol 2014; 15:1090-9. [PMID: 25150798 DOI: 10.1016/s1470-2045(14)70335-3] [Citation(s) in RCA: 277] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Ibrutinib, an orally administered covalent inhibitor of Bruton's tyrosine kinase (BTK), is an effective treatment for relapsed chronic lymphocytic leukaemia (CLL). We investigated the activity and safety of the combination of ibrutinib with the monoclonal antibody rituximab in patients with high-risk CLL. METHODS In this single-arm phase 2 study, we enrolled adult patients with high-risk CLL at the MD Anderson Cancer Center (Houston, TX, USA). All enrolled participants had high-risk cytogenetic abnormalities (deletion 17p, TP53 mutation, or deletion 11q) or a short progression-free survival (PFS <36 months) after previous first-line chemoimmunotherapy. Patients with symptomatic disease requiring therapy received 28-day cycles of once-daily ibrutinib 420 mg together with rituximab (375 mg/m(2), intravenously, every week during cycle 1, then once per cycle until cycle 6), followed by continuous daily single-agent ibrutinib 420 mg until disease progression or until toxicities or complications precluded further treatment. The primary endpoint was progression-free survival in the intention-to-treat population. This study is registered with ClinicalTrials.gov number NCT01520519, and is no longer accruing patients. FINDINGS Between Feb 28, 2012, and Sept 11, 2012, we enrolled 40 patients with CLL with high-risk disease features, 20 of whom had deletion 17p (del[17p]) or TP53 mutations (16 previously treated, four untreated), 13 had relapsed CLL with deletion 11q (del[11q]), and seven a PFS less than 36 months after first-line chemoimmunotherapy. 18-month PFS in all patients was 78·0% (95% CI 60·6-88·5), whereas in those with a del(17p) or TP53 mutation it was 72·4% (45·6-87·6) Toxicity was mainly mild to moderate in severity (grade 1-2). Diarrhoea occurred in ten (25%) patients (grade 1 in nine patients and grade 2 in one), bleeding events in 14 (33%) patients (eight grade 1 and five grade 2), nausea or vomiting in 15 patients (38%) (ten grade 1 and five grade 2), and fatigue in seven (18%) patients (four grade 1 and three grade 2). Five patients (13%) had grade 3 infections (two lung infections, one upper respiratory tract infection, one sepsis, and one mucositis), and no grade 4 or 5 infections occurred. One patient had grade 4 neutropenia. INTERPRETATION The encouraging safety and activity of ibrutinib and rituximab in this population of patients with high-risk CLL merits further investigation of this combination. FUNDING Pharmacyclics Inc, Cancer Prevention and Research Institute of Texas, Leukemia and Lymphoma Society, National Cancer Institute, MD Anderson Cancer Center.
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Affiliation(s)
- Jan A Burger
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA.
| | | | - William G Wierda
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA
| | - Elena Hartmann
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | | | - Nathalie Y Rosin
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA
| | - Iris de Weerdt
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Susan Lerner
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Gracy Zacharian
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA
| | - Xuelin Huang
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop Kantarjian
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA
| | - Naveen Garg
- Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Susan O'Brien
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA
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19
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van den Broek EC, Oerlemans S, Nijziel MR, Posthuma EF, Coebergh JW, van de Poll-Franse LV. Impact of active surveillance, chlorambucil, and other therapy on health-related quality of life in patients with CLL/SLL in the Netherlands. Ann Hematol 2015; 94:45-56. [PMID: 25038918 DOI: 10.1007/s00277-014-2161-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 07/02/2014] [Indexed: 11/12/2022]
Abstract
As survival of patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) increases and the number of patients who live long rises, health-related quality of life (HRQoL) becomes a relevant endpoint. Few studies investigated this, mainly as a secondary endpoint in randomized clinical trials where patients with early stage CLL/SLL, and elderly/frail patients were underrepresented. The aim of our study was to assess HRQoL in a population-based setting, including these previously underrepresented patients. Out of 175 patients diagnosed with CLL/SLL between 2004 and 2011, 136 (78 %) returned the HRQoL questionnaire. The outcomes were compared to an age- and sex-matched norm population. Detailed data on stage and treatment were extracted from a population-based hematological registry (PHAROS). Patients ever treated for CLL/SLL reported significantly poorer HRQoL than the norm population (p < 0.01 with large clinically important differences. Interestingly, no differences were observed between the norm population and patients under active surveillance. In contrast to our hypothesis, patients treated with chlorambucil reported the lowest HRQoL scores. Drastic, long-lasting negative effects of starting treatment on HRQoL cannot be excluded, whereas active surveillance does not seem to provoke worrying, anxiety, or depressive symptoms. Further elaborate research into the impact of starting therapy on HRQoL is needed, especially in patients that are underrepresented in most clinical trials, and thoroughly consider its results during revision of treatment guidelines.
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Mulligan SP, Karlsson K, Strömberg M, Jønsson V, Gill D, Hammerström J, Hertzberg M, McLennan R, Uggla B, Norman J, Wallvik J, Sundström G, Johansson H, Brandberg Y, Liliemark J, Juliusson G. Cladribine prolongs progression-free survival and time to second treatment compared to fludarabine and high-dose chlorambucil in chronic lymphocytic leukemia. Leuk Lymphoma 2014; 55:2769-77. [PMID: 24524339 DOI: 10.3109/10428194.2014.893306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We conducted a randomized phase III trial to compare the efficacy and safety of two purine analogs, cladribine and fludarabine, with high-dose chlorambucil, in patients with previously untreated chronic lymphocytic leukemia (CLL). Between 1997 and 2004, 223 patients with CLL were randomly assigned to cladribine, fludarabine or chlorambucil, for six cycles of therapy with frequent health-related quality of life assessments. There was no statistical difference for the primary endpoint of overall response with cladribine (70%), fludarabine (67%) and chlorambucil (59%), or complete remission (12%, 7% and 8%), respectively. However, the median progression-free survival (25, 10, 9 months) and median time to second treatment (40, 22, 21 months) were superior with cladribine. There was no significant difference in overall survival (96, 82 and 91 months), nor in toxicity or HRQoL assessments. Monotherapy with cladribine gives superior PFS and longer response duration than fludarabine and chlorambucil as first-line treatment of CLL.
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Affiliation(s)
- Stephen P Mulligan
- Department of Haematology, Royal North Shore Hospital , Sydney , Australia
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Sandoval MR, Balakrishnan K, Luthra R, Keating M, Gandhi V. DNA repair initiation induces expression of ribonucleotide reductase in human chronic lymphocytic leukemia cells. Leuk Lymphoma 2013; 55:876-83. [PMID: 23772636 DOI: 10.3109/10428194.2013.813497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mammalian ribonucleotide reductase (RR) is a heterodimer enzyme responsible for maintaining levels of deoxynucleotides needed for DNA replication. The M2 subunit of RR is known to increase in tandem with progression of cells into S phase, whereas the M1 subunit is expressed at steady-state. Since the expression level of the M2 subunit increases because the cells need deoxyribonucleoside triphosphates (dNTPs) for replication, it is logical to hypothesize that the same increase will be seen during DNA repair. To test this, we used chronic lymphocytic leukemia (CLL) cells, which are replicationally quiescent and have low endogenous levels of RR and dNTPs. Cyclophosphamide was selected as the DNA damaging agent because of its clinical use in the treatment of CLL. DNA repair, measured by [(3)H]thymidine incorporation after 4 h treatment with 4-hydroperoxycyclophosphamide, increased in a dose-dependent manner at 3, 10 and 50 μM. The induction of DNA repair concomitantly increased the mRNA and protein levels of M2 subunit (median 1.6-fold; range 0.9-5.3). Maximum induction occurred at 10 μM after 4 h and correlated with [(3)H]thymidine incorporation (p = 0.02). In contrast, no change was observed in mRNA or protein levels of M1 subunit. We conclude that RR is regulated not only during replication but also during DNA repair, and in both cases M2 subunit expression is increased.
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Michallet A, Cazin B, Bouvet E, Oberic L, Schlaifer D, Mosser L, Salles G, Coiffier B, Laurent G, Ysebaert L. First immunochemotherapy outcomes in elderly patients with CLL: A retrospective analysis. J Geriatr Oncol 2013; 4:141-7. [DOI: 10.1016/j.jgo.2013.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 11/28/2012] [Accepted: 01/29/2013] [Indexed: 11/20/2022]
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23
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Boltong A, Keast R. The influence of chemotherapy on taste perception and food hedonics: A systematic review. Cancer Treat Rev 2012; 38:152-63. [DOI: 10.1016/j.ctrv.2011.04.008] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 04/15/2011] [Accepted: 04/18/2011] [Indexed: 11/21/2022]
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Else M, Cocks K, Crofts S, Wade R, Richards SM, Catovsky D, Smith AG. Quality of life in chronic lymphocytic leukemia: 5-year results from the multicenter randomized LRF CLL4 trial. Leuk Lymphoma 2012; 53:1289-98. [PMID: 22168274 DOI: 10.3109/10428194.2011.649479] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Health-related quality of life (HRQoL) is a key issue for patients with chronic lymphocytic leukemia. The multicenter LRF CLL4 trial, in which 777 patients were randomized to receive chlorambucil or fludarabine, alone or with cyclophosphamide (FC), assessed HRQoL at baseline, months 3, 6 and 12, then annually until 5 years, using the European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC-QLQ-C30). While on treatment, some HRQoL impairment was seen in patients receiving fludarabine, particularly FC, compared with chlorambucil. Thus at 3 months, role/social functioning and fatigue were ≥ 10 points worse than baseline in 41%/46%/56%, respectively, of patients receiving fludarabine alone and 48%/54%/60% receiving FC, compared with only 29%/31%/40% of those receiving chlorambucil. Thereafter HRQoL appeared similar between treatment groups. Sustained remissions were associated with long-term HRQoL benefit. In the primary HRQoL domains patients still in complete or partial remission at each time-point had scores close to those reported in general population studies, while patients whose disease had progressed had mean scores up to 22 points worse, in spite of subsequent treatments. These data offer support for the use of primary treatment regimens likely to achieve and sustain remission in otherwise medically fit patients of all ages, including those aged > 70 years.
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Affiliation(s)
- Monica Else
- Haemato-Oncology Research Unit, Division of Molecular Pathology, The Institute of Cancer Research, Sutton, UK
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Boltong A, Keast R, Aranda S. Experiences and consequences of altered taste, flavour and food hedonics during chemotherapy treatment. Support Care Cancer 2012; 20:2765-74. [DOI: 10.1007/s00520-012-1398-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 02/03/2012] [Indexed: 10/28/2022]
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Affiliation(s)
- Clive S Zent
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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Scherber R, Dueck AC, Johansson P, Barbui T, Barosi G, Vannucchi AM, Passamonti F, Andreasson B, Ferarri ML, Rambaldi A, Samuelsson J, Birgegard G, Tefferi A, Harrison CN, Radia D, Mesa RA. The Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF): International Prospective Validation and Reliability Trial in 402 patients. Blood 2011; 118:401-8. [DOI: 10.1182/blood-2011-01-328955] [Citation(s) in RCA: 228] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Symptomatic burden in myeloproliferative neoplasms is present in most patients and compromises quality of life. We sought to validate a broadly applicable 18-item instrument (Myeloproliferative Neoplasm Symptom Assessment Form [MPN-SAF], coadministered with the Brief Fatigue Inventory) to assess symptoms of myelofibrosis, essential thrombocythemia, and polycythemia vera among prospective cohorts in the United States, Sweden, and Italy. A total of 402 MPN-SAF surveys were administered (English [25%], Italian [46%], and Swedish [28%]) in 161 patients with essential thrombocythemia, 145 patients with polycythemia vera, and 96 patients with myelofibrosis. Responses among the 3 administered languages showed great consistency after controlling for MPN subtype. Strong correlations existed between individual items and key symptomatic elements represented on both the MPN-SAF and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30. Enrolling physicians' blinded opinion of patient symptoms (6 symptoms assessed) were highly correlated with corresponding patients' responses. Serial administration of the English MPN-SAF among 53 patients showed that most MPN-SAF items are well correlated (r > 0.5, P < .001) and highly reproducible (intraclass correlation coefficient > 0.7). The MPN-SAF is a comprehensive and reliable instrument that is available in multiple languages to evaluate symptoms associated with all types of MPNs in clinical trials globally.
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Tam CS. In defence of the use of modern chemotherapy regimens for the treatment of patients with chronic lymphocytic leukaemia. Intern Med J 2010; 39:858-9. [PMID: 20233254 DOI: 10.1111/j.1445-5994.2009.02071.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Eichhorst BF, Busch R, Stilgenbauer S, Stauch M, Bergmann MA, Ritgen M, Kranzhöfer N, Rohrberg R, Söling U, Burkhard O, Westermann A, Goede V, Schweighofer CD, Fischer K, Fink A, Wendtner CM, Brittinger G, Döhner H, Emmerich B, Hallek M; the German CLL Study Group (GCLLSG). First-line therapy with fludarabine compared with chlorambucil does not result in a major benefit for elderly patients with advanced chronic lymphocytic leukemia. Blood 2009; 114:3382-91. [DOI: 10.1182/blood-2009-02-206185] [Citation(s) in RCA: 261] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Although chronic lymphocytic leukemia (CLL) is a disease of elderly patients, subjects older than 65 years are heavily underrepresented in clinical trials. The German CLL study group (GCLLSG) initiated a multicenter phase III trial for CLL patients older than 65 years comparing first-line therapy with fludarabine with chlorambucil. A total of 193 patients with a median age of 70 years were randomized to receive fludarabine (25 mg/m2 for 5 days intravenously, every 28 days, for 6 courses) or chlorambucil (0.4 mg/kg body weight [BW] with an increase to 0.8 mg/kg, every 15 days, for 12 months). Fludarabine resulted in a significantly higher overall and complete remission rate (72% vs 51%, P = .003; 7% vs 0%, P = .011). Time to treatment failure was significantly shorter in the chlorambucil arm (11 vs 18 months; P = .004), but no difference in progression-free survival time was observed (19 months with fludarabine, 18 months with chlorambucil; P = .7). Moreover, fludarabine did not increase the overall survival time (46 months in the fludarabine vs 64 months in the chlorambucil arm; P = .15). Taken together, the results suggest that in elderly CLL patients the first-line therapy with fludarabine alone does not result in a major clinical benefit compared with chlorambucil. This trial is registered with www.isrctn.org under identifier ISRCTN 36294212.
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Abstract
Fludarabine (FAMP) is the most effective and most extensively studied purine analog in indolent B-cell malignancies. Its use is indicated for first-and second-line treatment of B-cell chronic lymphocytic leukemia (B-CLL). FAMP as a single agent has produced superior response rates and progression-free survival than standard therapy with chlorambucil and alkylator-based regimen. Efficacy of FAMP may be increased by combining this purine analog with other chemotherapeutic and non-chemotherapeutic agents. FAMP and cyclophosphamide combination (FC) has shown promising results with higher overall response and complete response rates than FAMP in monotherapy, although no difference has been detected in survival. Quality of response and eradication of minimal residual disease (MRD) have been reported to be associated with prolonged survival. Eradication of MRD has been achieved by combining FC with mitoxantrone or monoclonal antibody including alemtuzumab or rituximab or both. FAMP has been widely used in non-myeloablative conditioning regimens, often combined with a variety of other cytotoxic agents, with the aim of inducing enough immunosuppression to allow successful engraftment and to exert some pretransplant anti-tumor activity. The current paper provides an overview of use of FAMP as a single agent or as a cornerstone of different therapeutic strategies for treatment of B-CLL patients.
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Affiliation(s)
- Francesca Ricci
- Department of Oncology/Haematology, Niguarda Ca’Granda Hospital, Milan, Italy
| | - Alessandra Tedeschi
- Department of Oncology/Haematology, Niguarda Ca’Granda Hospital, Milan, Italy
| | - Enrica Morra
- Department of Oncology/Haematology, Niguarda Ca’Granda Hospital, Milan, Italy
| | - Marco Montillo
- Department of Oncology/Haematology, Niguarda Ca’Granda Hospital, Milan, Italy
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Else M, Smith AG, Cocks K, Richards SM, Crofts S, Wade R, Catovsky D. Patients’ experience of chronic lymphocytic leukaemia: baseline health-related quality of life results from the LRF CLL4 trial. Br J Haematol 2008; 143:690-7. [DOI: 10.1111/j.1365-2141.2008.07407.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Herbert KE, Morgan S, Prince HM, Westerman DA, Wolf MM, Carney DA, Yuen K, di Iulio J, Seymour JF. Stem cell factor and high-dose twice daily filgrastim is an effective strategy for peripheral blood stem cell mobilization in patients with indolent lymphoproliferative disorders previously treated with fludarabine: results of a Phase II study with an historical comparator. Leukemia 2009; 23:305-12. [DOI: 10.1038/leu.2008.302] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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33
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Herbst C, Monsef I, Skötz N, Engert A. Eighth biannual report of the Cochrane Haematological Malignancies Group--focus on chronic lymphatic leukemia. J Natl Cancer Inst 2008; 100:E1. [PMID: 18664654 DOI: 10.1093/jnci/djn212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Christine Herbst
- Department of Internal Medicine 1, Cochrane Haematological Malignancies Group, University Hospital of Cologne, Cologne, Germany.
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Shanafelt TD, Bowen DA, Venkat C, Slager SL, Zent CS, Kay NE, Reinalda M, Tun H, Sloan JA, Call TG. The physician-patient relationship and quality of life: lessons from chronic lymphocytic leukemia. Leuk Res 2009; 33:263-70. [PMID: 18656259 DOI: 10.1016/j.leukres.2008.06.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 06/16/2008] [Accepted: 06/17/2008] [Indexed: 11/21/2022]
Abstract
We evaluated patients' satisfaction with the physician caring for them as part of an international web-based survey of quality of life (QOL) in patients with chronic lymphocytic leukemia (CLL; n=1482). Over half (55.9%) of patients thought about their diagnosis daily. Although >90% felt their doctor understood how their disease was progressing (i.e., stage, blood counts, nodes), <70% felt their physician understood how CLL affected their QOL (anxiety, worry, fatigue). Reported satisfaction with their physician in a variety of areas strongly related to patients' measured emotional and overall QOL (all p<0.001). Physician use of specific euphemistic phrases to characterize CLL (e.g., "CLL is the 'good' leukemia") was also associated with lower emotional QOL among patients (p<0.001). These effects on QOL remained (p<0.001) after adjustment for age, co-morbid health conditions, fatigue, and treatment status. The effectiveness with which physicians help patients adjust to the physical, intellectual, and emotional challenges of CLL appears to impact patient QOL.
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Hallek M, Cheson BD, Catovsky D, Caligaris-Cappio F, Dighiero G, Döhner H, Hillmen P, Keating MJ, Montserrat E, Rai KR, Kipps TJ. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute-Working Group 1996 guidelines. Blood 2008; 111:5446-56. [PMID: 18216293 PMCID: PMC2972576 DOI: 10.1182/blood-2007-06-093906] [Citation(s) in RCA: 2412] [Impact Index Per Article: 150.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2007] [Accepted: 12/15/2007] [Indexed: 01/06/2023] Open
Abstract
Standardized criteria for diagnosis and response assessment are needed to interpret and compare clinical trials and for approval of new therapeutic agents by regulatory agencies. Therefore, a National Cancer Institute-sponsored Working Group (NCI-WG) on chronic lymphocytic leukemia (CLL) published guidelines for the design and conduct of clinical trials for patients with CLL in 1988, which were updated in 1996. During the past decade, considerable progress has been achieved in defining new prognostic markers, diagnostic parameters, and treatment options. This prompted the International Workshop on Chronic Lymphocytic Leukemia (IWCLL) to provide updated recommendations for the management of CLL in clinical trials and general practice.
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Affiliation(s)
- Michael Hallek
- Klinik I für Innere Medizin, Universität zu Köln, Köln, Germany.
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Efficace F, Kemmler G, Vignetti M, Mandelli F, Molica S, Holzner B. Health-related quality of life assessment and reported outcomes in leukaemia randomised controlled trials - a systematic review to evaluate the added value in supporting clinical decision making. Eur J Cancer 2008; 44:1497-506. [PMID: 18555682 DOI: 10.1016/j.ejca.2008.03.017] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 03/20/2008] [Indexed: 11/23/2022]
Abstract
Health-related quality of life (HRQOL) is increasingly reported as an important outcome in cancer clinical trials. However, very little evidence exists on the impact of such evaluation in randomised controlled trials (RCTs) of leukaemia patients. A systematic search of the literature from 1980 to 2007 was undertaken and studies were identified and evaluated independently, according to a pre-defined coding scheme, by three reviewers. Both HRQOL outcomes and traditional clinical reported outcomes were systematically analysed to evaluate their consistency and their relevance for supporting clinical decision making. Nine RCTs were identified, involving 3838 patients overall. There were four RCTs involving acute myeloid leukaemia patients (AML), three with chronic myeloid leukaemia (CML) and two with chronic lymphocytic leukaemia (CLL). Six studies were published after 2000 and provided fairly robust methodological quality. Imatinib greatly improved HRQOL compared to interferon based treatments in CML patients and fludarabine plus cyclophosphamide does not seem to have a deleterious impact on patient's HRQOL when compared to fludarabine alone or chlorambucil in CLL patients. This study revealed the paucity of HRQOL research in leukaemia patients. Nonetheless, HRQOL assessment is feasible in RCTs and has the great potential of providing valuable outcomes to further support clinical decision making.
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Shanafelt TD, Bowen D, Venkat C, Slager SL, Zent CS, Kay NE, Reinalda M, Sloan JA, Call TG. Quality of life in chronic lymphocytic leukemia: an international survey of 1482 patients. Br J Haematol 2008; 139:255-64. [PMID: 17897301 DOI: 10.1111/j.1365-2141.2007.06791.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although a diagnosis of chronic lymphocytic leukemia (CLL) can have a profound effect on the quality of life (QOL), few studies have objectively measured the QOL of CLL patients or compared it to the general population. We conducted an international, web-based survey of patients with CLL using standardized instruments with published population norms to evaluate fatigue and QOL. Co-morbid health conditions were assessed using the Charlson Co-Morbidity Index. Between June and October 2006, 1482 patients with CLL responded to the survey. The physical, social/family, functional, and overall QOL scores of CLL patients were similar to or better than published population norms. In contrast, the emotional well-being scores of CLL patients were dramatically lower than that of both the general population (P < 0.001) and patients with other types of cancer (P < 0.001). QOL scores were lower among individuals with advanced stage disease (all P < 0.05). Factors associated with lower overall QOL on multivariate analysis included older age, greater fatigue, severity of co-morbid health conditions, and current treatment. CLL has a profound impact on QOL at all disease stages. The effects of CLL on QOL appear to differ from that of other malignancies with a more marked impact on emotional QOL. Research identifying efficacious psycho-oncologic support interventions for patients with CLL is needed.
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Current Awareness in Hematological Oncology. Hematol Oncol 2008. [DOI: 10.1002/hon.830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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39
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Abstract
Abstract
The current management of B-chronic lymphocytic leukemia (CLL) is no longer straightforward for the practicing hematologist. Rapid advances in diagnostic precision, methods of predicting prognosis, understanding of natural history of CLL, recognition of clinical complications, clarification of the quality of life (QOL) issues facing the CLL patient, and the exciting array of novel treatment approaches have made the care of the CLL patient more demanding. This review is focused on summarizing these advances in order to provide a framework for integrating this knowledge into routine hematologic practice.
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Abstract
The current management of B-chronic lymphocytic leukemia (CLL) is no longer straightforward for the practicing hematologist. Rapid advances in diagnostic precision, methods of predicting prognosis, understanding of natural history of CLL, recognition of clinical complications, clarification of the quality of life (QOL) issues facing the CLL patient, and the exciting array of novel treatment approaches have made the care of the CLL patient more demanding. This review is focused on summarizing these advances in order to provide a framework for integrating this knowledge into routine hematologic practice.
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MESH Headings
- Counseling
- Holistic Health
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Neoplasm, Residual
- Prognosis
- Quality of Life
- Salvage Therapy
- Stem Cell Transplantation
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Affiliation(s)
- Tait D Shanafelt
- Mayo Clinic, 200 First Street, Stabile 6-28, Rochester, MN 55905-0001, USA
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