An observational study of outcomes after initial infused therapy in Medicare patients diagnosed with chronic lymphocytic leukemia

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BlankBlood First Edition Paper, prepublished online December 29, 2010; DOI

10.1182/blood-2010-08-301929.

An observational study of outcomes after initial infused therapy in Medicare

patients diagnosed with chronic lymphocytic leukemia

Mark D. Danese1,*, I. Griffiths1, Gleeson1, Sacha Satram-Hoang2,

Knopf3, ph Mikhael4 and Carolina Reyes2

1 Outcomes Insights, Inc., Westlake Village, CA, United States; 2 Genentech,

Inc., South San Francisco, CA, United States; 3 California Pacific Medical

Center, San Francisco, CA, United States; 4 Mayo Clinic Arizona, sdale, AZ,

United States

* Corresponding author; email: mark@...

Abstract

The study goal was to characterize older chronic lymphocytic leukemia (CLL)

patients and to evaluate outcomes in those patients who initiated infused

therapy. Patients age >- 66 in the SEER program with a CLL diagnosis were

matched to their Medicare Part A and Part B claims for long-term follow-up.

Treatment patterns, survival after initiation of infused therapy, and both

hematological and hospitalization outcomes were assessed. There were 6,433 CLL

patients identified, and 2,040 received infused therapy. Treated patients were

categorized as receiving rituximab monotherapy (16%), rituximab plus

chemotherapy (14%), and chemotherapy alone (70%) based on the initial 60 days

after infusion. The use of rituximab plus chemotherapy compared to chemotherapy

alone was associated with a 25% lower risk of overall mortality (95% CI 9% to

38%). Restricting to patients age >- 70 did not change the risk reduction for

rituximab plus chemotherapy. Hematological interventions were more common with

rituximab plus chemotherapy compared to chemotherapy alone, but there was no

difference in all-cause hospitalizations. These analyses, though based on

observational and not clinical trial data, suggest that the benefits of initial

therapy with rituximab in a heterogeneous group of older CLL patients are

comparable to those demonstrated in earlier studies and in younger patients.