PROGNOSTICATION AND FIRST-LINE TREATMENT IN CHRONIC LYMPHOCYTIC LEUKEMIA: A CONTEMPORARY, NATIONWIDE, POPULATION-BASED ANALYSIS AMONG 1,677 PATIENTS DIAGNOSED IN THE NETHERLANDS
Author(s): ,
Lina Van Der Straten
Affiliations:
Research,Netherlands Comprehensive Cancer Organisation (IKNL),Utrecht,Netherlands;Internal Medicine,Albert Schweitzer Hospital,Dordrecht,Netherlands
,
Mark-David Levin
Affiliations:
Internal Medicine,Albert Schweitzer Hospital,Dordrecht,Netherlands
,
Otto Visser
Affiliations:
Registration,Netherlands Comprehensive Cancer Organisation (IKNL),Utrecht,Netherlands
,
Eduardus F.M. Posthuma
Affiliations:
Internal Medicine,Reinier The Graaf Hospital,Delft,Netherlands;Hematology,Leiden University Medical Center,Leiden,Netherlands
,
Jeanette K. Doorduijn
Affiliations:
Hematology,Erasmus MC Cancer Institute,Rotterdam,Netherlands
,
Arnon P. Kater
Affiliations:
Hematology,Academic Medical Center,Amsterdam,Netherlands
Avinash G. Dinmohamed
Affiliations:
Research,Netherlands Comprehensive Cancer Organisation (IKNL),Utrecht,Netherlands;Hematology,Erasmus MC Cancer Institute,Rotterdam,Netherlands;Public Health,Erasmus University Medical Center,Rotterdam,Netherlands
(Abstract release date: 05/17/18) EHA Library. van der Straten L. 06/16/18; 215414; PS1100
Lina van der Straten
Lina van der Straten
Contributions
Abstract

Abstract: PS1100

Type: Poster Presentation

Presentation during EHA23: On Saturday, June 16, 2018 from 17:30 - 19:00

Location: Poster area

Background

The natural history of chronic lymphocytic leukemia (CLL) is heterogeneous. Therefore, accurate prognostication is pivotal to predict outcome and plan risk-adapted therapy. At present, it is virtually unknown how prognostic tests and first-line treatment are applied among CLL patients at the population level.

Aims

The aim of this nationwide, population-study was to assess how prognostic tests and first-line treatment were utilized among CLL patients diagnosed in a contemporary era in the Netherlands.

Methods

We selected all CLL patients diagnosed between 2014-2015 from the nationwide Netherlands Cancer Registry (NCR) with follow-up for survival until December 31, 2016. Information on cytogenetic (ie, karyotyping and/or FISH) and molecular testing, Rai stage, and first-line treatment started within one year after diagnosis is available in the NCR as from 2014 onward. Multivariable logistic regression (MLR) analysis was used to assess factors associated with cytogenetic testing and first-line treatment, adjusted for covariates presented in the Figure. One-year relative survival (RS) was calculated as a measure of early excess mortality (EEM). P<0.05 indicates statistical significance.

Results

A total of 1,667 CLL patients (median age 69 years; 63% males) was included in the study. Patient characteristics are presented in Table 1. The Rai stage was undeterminable in 139 (8%) patients because at least one of the parameters that compose the Rai stage was missing. Cytogenetic and molecular testing were performed in 435 (26%) and 106 (6%) of patients, respectively. Del(17p) and TP53 mutations were detected in 12 of 435 (3%) and 6 of 106 (6%) patients, respectively. First-line therapy was started in 347 (21%) patients. R-Chl (36%; median age 77; interquartile range [IQR] 72-81) and FCR (30%; median age 61; IQR 56-65) were the most commonly applied therapies. Following MLR analysis, age per 10-year increase and female sex were associated with unperformed cytogenetics, whereas cytogenetic testing was more likely performed among patients diagnosed in academic centers, patients with Rai stage ≥1, and patients who started first-line treatment (Table 2). Now turning to variables associated with the start of first-line treatment (Table 3). Comorbidity per one condition increase and Rai stage 0-1 were factors associated with a lower odds to start first-line treatment. Conversely, patients with Rai stage 3-4 and patients in whom cytogenetic and molecular testing were performed were more likely to start with first-line therapy (Table 3). One-year RS (95% confidence intervals) was 100% (98%>101%), 99% (95%>101%), 97% (93%>100%), 87% (80%>92%), and 85% (76%>91%) for patients with Rai stage 0, 1, 2, 3, and 4, respectively.  

Conclusion

This is the first population-based study showing how prognostic procedures and first-line treatment are utilized among CLL patients diagnosed in a contemporary era. Congruent with clinical practice guidelines, most, but not all, CLL patients with advanced disease and who started with first-line therapy underwent (cyto)genetic testing. A novel, although expected finding was that patients with Rai stage 0-2 do not experience EEM, whereas patients with Rai stage 3-4 experience considerable EEM, as compared with the general population. To date, no study has presented such outcomes corrected for the life expectancy in the general population. Collectively, population-based registries are useful instruments to assess guideline adherence and the prognostic value of staging systems at the population level. 

Session topic: 6. Chronic lymphocytic leukemia and related disorders - Clinical

Keyword(s): Chronic Lymphocytic Leukemia, epidemiology, Survival, Treatment

Abstract: PS1100

Type: Poster Presentation

Presentation during EHA23: On Saturday, June 16, 2018 from 17:30 - 19:00

Location: Poster area

Background

The natural history of chronic lymphocytic leukemia (CLL) is heterogeneous. Therefore, accurate prognostication is pivotal to predict outcome and plan risk-adapted therapy. At present, it is virtually unknown how prognostic tests and first-line treatment are applied among CLL patients at the population level.

Aims

The aim of this nationwide, population-study was to assess how prognostic tests and first-line treatment were utilized among CLL patients diagnosed in a contemporary era in the Netherlands.

Methods

We selected all CLL patients diagnosed between 2014-2015 from the nationwide Netherlands Cancer Registry (NCR) with follow-up for survival until December 31, 2016. Information on cytogenetic (ie, karyotyping and/or FISH) and molecular testing, Rai stage, and first-line treatment started within one year after diagnosis is available in the NCR as from 2014 onward. Multivariable logistic regression (MLR) analysis was used to assess factors associated with cytogenetic testing and first-line treatment, adjusted for covariates presented in the Figure. One-year relative survival (RS) was calculated as a measure of early excess mortality (EEM). P<0.05 indicates statistical significance.

Results

A total of 1,667 CLL patients (median age 69 years; 63% males) was included in the study. Patient characteristics are presented in Table 1. The Rai stage was undeterminable in 139 (8%) patients because at least one of the parameters that compose the Rai stage was missing. Cytogenetic and molecular testing were performed in 435 (26%) and 106 (6%) of patients, respectively. Del(17p) and TP53 mutations were detected in 12 of 435 (3%) and 6 of 106 (6%) patients, respectively. First-line therapy was started in 347 (21%) patients. R-Chl (36%; median age 77; interquartile range [IQR] 72-81) and FCR (30%; median age 61; IQR 56-65) were the most commonly applied therapies. Following MLR analysis, age per 10-year increase and female sex were associated with unperformed cytogenetics, whereas cytogenetic testing was more likely performed among patients diagnosed in academic centers, patients with Rai stage ≥1, and patients who started first-line treatment (Table 2). Now turning to variables associated with the start of first-line treatment (Table 3). Comorbidity per one condition increase and Rai stage 0-1 were factors associated with a lower odds to start first-line treatment. Conversely, patients with Rai stage 3-4 and patients in whom cytogenetic and molecular testing were performed were more likely to start with first-line therapy (Table 3). One-year RS (95% confidence intervals) was 100% (98%>101%), 99% (95%>101%), 97% (93%>100%), 87% (80%>92%), and 85% (76%>91%) for patients with Rai stage 0, 1, 2, 3, and 4, respectively.  

Conclusion

This is the first population-based study showing how prognostic procedures and first-line treatment are utilized among CLL patients diagnosed in a contemporary era. Congruent with clinical practice guidelines, most, but not all, CLL patients with advanced disease and who started with first-line therapy underwent (cyto)genetic testing. A novel, although expected finding was that patients with Rai stage 0-2 do not experience EEM, whereas patients with Rai stage 3-4 experience considerable EEM, as compared with the general population. To date, no study has presented such outcomes corrected for the life expectancy in the general population. Collectively, population-based registries are useful instruments to assess guideline adherence and the prognostic value of staging systems at the population level. 

Session topic: 6. Chronic lymphocytic leukemia and related disorders - Clinical

Keyword(s): Chronic Lymphocytic Leukemia, epidemiology, Survival, Treatment

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