Survival outcomes after initial infused therapy for elderly chronic lymphocytic leukemia (CLL) patients.

May 26, 2010

BlankSurvival outcomes after initial infused therapy for elderly chronic

lymphocytic leukemia (CLL) patients.

Sub-category: Leukemia

Category: Leukemia, Myelodysplasia, and Transplantation

Meeting: 2010 ASCO Annual Meeting

Citation: J Clin Oncol 28:7s, 2010 (suppl; abstr 6565)

Abstract No: 6565

Author(s): M. Danese, R. Griffiths, M. Gleeson, S. Satram-Hoang, K. B. Knopf, J.

Mikhael, C. M. Reyes; Outcomes Insights, Inc., Westlake Village, CA; Genentech,

South San Francisco, CA; California Pacific Medical Center, San Francisco, CA;

Mayo Clinic, sdale, AZ

Abstract:

Background: Over 70% of CLL patients are > 65 years old at diagnosis. However,

real-world studies of elderly patients are few, and little is known about

outcomes in the elderly. Methods: Using the SEER-Medicare data, we studied the

initial use of infused therapies in CLL patients (age > 65) diagnosed from 1999

to 2005, and followed through 2007. We compared outcomes for patients taking

rituximab with chemotherapy (R+CT) versus CT alone. Diagnosis and procedure

codes in the claims data were used to identify more advanced disease (diagnosis

of anemia or thrombocytopenia, used as a proxy for stage), key comorbid

conditions, and therapies. Data on oral therapy was not available. Proportional

hazards regression was used for survival, adjusting for age, gender, advanced

stage, comorbidities, year and region. Results: We identified 6,426 new CLL

patients (mean age 78, mean follow-up 40 months), of whom 2,231 initiated

infused therapy. Factors associated with a lower likelihood (p < 0.05) of

receiving initial infused therapy include age > 75, female, other race (neither

black nor white), not being advanced stage, and = 3 comorbidities. Of treated

patients, 185 (8.3%) had hemolytic anemia and 1,091 (49%) had advanced disease.

In total, 317 (14%) used R with no other CT, 286 (13%) used R+CT, and the

remainder used CT alone. In adjusted models, R+CT was associated with a 21%

lower risk of death compared to CT alone (HR = 0.79, 95% CI 0.65 to 0.95). In

patients without advanced disease, mortality risk was 34% lower for R+CT (HR

0.66, 95% CI 0.49 to 0.89), but there was no difference among patients with

advanced disease (HR 0.90, 95% CI 0.70 to 1.17). Incidences of some hematologic

diagnoses within 180 days of starting therapy were higher with R+CT compared to

CT alone (anemia: 49% vs. 39%, p = 0.05; neutropenia: 35% vs. 18%, p < 0.001;

thrombocytopenia: 10% each). Because all severity levels are included, these

rates are not comparable to grade 3-4 rates from clinical trials. Conclusions:

In this elderly cohort, initial infused therapy with R+CT was associated with

lower mortality compared to CT alone.

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