Genetic Risk Affects First-Line Chemoimmunotherapy Outcomes for CLL/SLL

Compared with patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) identified as not high risk, patients with high-risk genetic abnormalities who initiated first-line chemoimmunotherapy had shorter time to treatment failure and time to next treatment or death, as well as significantly higher costs, according to an abstract presented at the 2021 ASCO Annual Meeting.

This study investigated real-world clinical and economic outcomes in high-risk and perceived non-high-risk patients initiating first-line chemoimmunotherapy for CLL/SLL. Researchers obtained medical records for patients from a national managed care population who initiated first-line chemotherapy and who underwent prognostic testing to classify them as high risk (del17p, TP53 mutation, del11q or unmutated IGHV) or as non-high risk (non-del17p and non-del11q) by fluorescence in situ hybridization (FISH) only.

According to the abstract, just 612 out of 1808 patients with CLL/SLL were FISH or IGHV tested. Between 2007 and 2019, however, the testing rate increased from 30% to 44%.

Among 253 patients for whom risk status was available, 119 were considered high risk and 134 were considered non-high risk. The rate of initiating first-line BR/FCR-based therapy was 80% in both cohorts.

The median time to next treatment or death was 2.4 years for patients who were high risk and 3.7 years for patients not at high risk, according to the study. Median time to treatment failure was 3 years for patients at high risk compared with 4.9 years for patients not at high risk.

Total plan-paid medical and pharmacy costs per patient per month in the first-line period were $12,194 for patients at high risk compared with $9055 for patients not at high risk.

“Assessment of cytogenetic/molecular risk status for appropriate treatment is vital to optimize clinical and economic outcomes, especially in the novel agent era,” researchers concluded. “Recent testing practices to assess genetic risk in chronic lymphocytic leukemia remains suboptimal.”

Reference:
Leslie LA, Gangan N, Tan H, Huang Q. Clinical and economic burden among patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) receiving first-line (1L) chemoimmunotherapy (CIT) by risk status: a chart-linked claims analysis. Abstract presented at 2021 ASCO Annual Meeting; June 4-8, 2021.