Reduction of Specialized Follow-Ups for Patients With Asymptomatic and Low-to-Intermediate Risk CLL

According to research published in Blood Advances, data demonstrated safety and feasibility in ending specialized follow-ups for specific treatment-naïve patients with chronic lymphocytic leukemia (CLL), who have low-to-intermediate risk CLL International Prognostic Index (CLL-IPI) and CLL without need of treatment (CLL-WONT) scores.

“Ending specialized surveillance for patients identified with the lowest of risks to progress toward need of treatment may be an attractive option for patients and for prioritization of health care resources, especially in countries with an increasing elderly population,” stated lead study investigator Christian Brieghel, MD, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark, and colleagues.

To evaluate the feasibility and safety of ending specialized follow-ups, researchers investigated 3-year clinical outcomes among 112 patients selected by clinical assessment to end follow-ups as compared with 88 patients selected to continue the follow-ups. It was noted that patients who ended specialized follow-ups were older but were otherwise lower risk compared with patients continuing follow-ups.

Study results demonstrated the overall survival (OS) was similar in patients ending and continuing specialized follow-ups (3-year OS, 87% and 80%, respectively; P = .16). Additionally, hospital visits per patient-year were lower (median 0.7 vs 4.3, P < .0001) and the time to first infection was longer (P = .035) in patients who were ending specialized follow-ups compared with those who continued. This included shorter in-hospital antimicrobial treatment (median 4 vs 12 days, respectively; P = .026).

Investigators noted that 1 in 6 patients were rereferred, including 4 patients who met international workshop on CLL criteria for need of treatment. Furthermore, this resulted in a lower 3-year first treatment rate for patients ending specialized follow-ups compared with patients who did not (4% vs 23%, respectively; P < .0001).

“We demonstrate that more than half of patients who were treatment-naïve with both CLL-IPI and CLL-WONT low-to-intermediate risk may safely be selected to end [specialized follow-ups],” concluded Dr Brieghel.

Source:

Brieghel C, Cunha-Bang C, Mourek J, et al. It is feasible and safe to stop specialized follow-up of asymptomatic lower-risk chronic lymphocytic leukemia. Blood Adv. Published online August 27, 2024. doi: 10.1182/bloodadvances.2023012382