Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in the Western world. In the United States, there will be an estimated 18,960 new cases of CLL and 4660 deaths due to CLL in 2016; the incidence is 4.5 per 100,000 based on 2008-2012 data.1 CLL is a disease of the elderly; the median age at diagnosis in the United States is 71 years, whereas only 11% of patients are younger than 55 years.1 Median survival ranges from 2 to more than 10 years, depending on a patient’s medical conditions and disease characteristics. Combination chemotherapy with either fludarabine, cyclophosphamide, and rituximab (FCR) or bendamustine plus rituximab (BR) is the standard-of-care first-line therapy for CLL without del17p.2 Using administrative claims data, Gabriel and colleagues reported on an analysis to examine differences in healthcare utilization between 2 cohorts of newly diagnosed CLL patients undergoing BR or FCR therapy, with a further analysis of differences across age groups.
Newly diagnosed CLL patients treated with first-line BR or FCR were identified from the Truven Health MarketScan Research Databases. Of 1795 CLL patients identified, 946 were in the BR cohort and 849 patients were in the FCR cohort. The BR cohort was significantly older, comprised more females, and had more frequent comorbid conditions relative to FCR patients (P<0.05 for all differences). The BR cohort experienced significantly fewer outpatient visits than the FCR cohort over the course of enrollment during the first 6 months of therapy and during months 12 to 18 (14.05 vs 17.03; P<0.05). The BR cohort was consistently less likely to experience an emergency department (ED) visit or hospitalization than the FCR cohort across all follow-up periods (overall risk [OR], 0.66; P<0.05). Differences between the cohorts were particularly salient for the FCR patients who were 70 years or older, who experienced, on average, more outpatient visits as well as had a greater likelihood of an ED visit or hospitalization stay, although these differences did not reach statistical significance (OR for ED visit 1.14; P>0.05; OR for hospitalization 1.50; P=0.11).
The authors concluded that the results of this analysis suggest that, in general, the healthcare utilization of CLL patients who remain on BR is significantly lower than patients who remain on FCR. Patients aged ≥70 years receiving FCR experienced significantly more days of hospitalization, outpatient visits, and ED visits than patients of the same age treated with BR. These results support BR as an effective and safe chemoimmunotherapy option for elderly CLL patients in the era of novel agents. Additional research is needed to examine differences in the supportive care needs and caregiver burden of CLL patients treated with FCR versus BR.
Gabriel S, et al. ASH 2016. Abstract 2406.
- Bachow SH, Lamanna N. Curr Hematol Malign Rep. 2016;11:61-70.