Variation in health-related quality of life (HRQOL) by line of therapy, age, and gender among patients with chronic lymphocytic leukemia.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 7086-7086
Author(s):  
Christopher Flowers ◽  
Charles Michael Farber ◽  
Ian Flinn ◽  
David L. Grinblatt ◽  
Neil E. Kay ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Statistical Significance ◽  
The United States ◽  
Lymphocytic Leukemia ◽  
Age Group ◽  
First Line ◽  
Hrqol Score ◽  
Age And Gender ◽  
And Gender ◽  
Line Of Therapy

7086 Background: The HRQOL of patients (pts) with chronic lymphocytic leukemia (CLL) has not been adequately delineated across patient, disease and treatment characteristics. We evaluated HRQOL of CLL pts undergoing treatment in the United States (US) by age, gender and line of therapy. Methods: Data were collected in Connect CLL, a prospective observational US registry. Physicians provided data on demographics, clinical characteristics and line of therapy at enrollment. HRQOL was self-reported by pts at enrollment using the Functional Assessment of Cancer Therapy-Leukemia, an instrument that yields a leukemia-specific total HRQOL score (FACT-Leu) and a cancer-specific total HRQOL score (FACT-G). Mean total scores were analyzed by line of therapy, age and gender. Statistical significance was ascertained by ANOVA using SAS 9.2. Multivariate analyses were conducted to assess the relative association of line of therapy, age and gender with HRQOL. Results: Among 1,252 pts enrolled from 161 geographically diverse centers (90% community, 8% academic, 2% veterans/military), pts were predominantly male (63%), white (89%) with mean age 69 yrs. Pts were categorized by line of therapy at enrollment: First 61%, Second 18%, Third 11%, Higher 9%; and by age group: <65 33%, 65-74 35%, 75+ 32%. Univariate analyses suggested that the total FACT-Leu score was significantly better in men than women (P=0.004); in pts aged 65-74 vs younger or older pts (P=0.033); and in pts initiating first-line treatment vs pts receiving subsequent treatments (P=0.0002). Similar results were found with the FACT-G score except that gender differences were not statistically significant. Multivariate analysis confirmed that line of therapy (P=0.007), gender (P<0.0001), and age group (P=0.039) were each associated with significant differences in the FACT-Leu total score. Conclusions: Results from the Connect CLL Registry indicate that HRQOL is better among pts initiating first-line therapy compared to pts initiating subsequent treatments, and that this remains true when age and gender are considered. Future analyses should determine how HRQOL may change over time relative to treatment and treatment response.

How Many Life Years Have Been Saved In The United States From Using Rituximab Plus Chemotherapy Compared To Chemotherapy Alone From 1998-2013

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2937-2937
Author(s):  
Mark Danese ◽  
Michelle Gleeson ◽  
Marc Halperin ◽  
Sandra Skettino ◽  
Carolina Reyes
Keyword(s):  
United States ◽  
Research Funding ◽  
B Cell Lymphoma ◽  
The United States ◽  
Incidence Rates ◽  
Lymphocytic Leukemia ◽  
Age Group ◽  
First Line ◽  
Medicare Data ◽  
Life Years

Abstract Introduction Rituximab was approved in December 1997 and has since become the standard of care in diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), and chronic lymphocytic leukemia (CLL). Clinical trials have shown statistically significant improvements in progression-free and overall survival. The objective of this study was to estimate the real-world effectiveness of first-line rituximab plus chemotherapy (R+Chemo) relative to chemotherapy alone (Chemo Alone) in the United States (US) from 1998 to 2013. Methods For each cancer, we constructed a population effectiveness model from 1998-2013 comprised of 3 modules: epidemiology, utilization and survival. The epidemiology module included age group, gender, and year-specific incidence rates for each cancer from the Surveillance, Epidemiology, and End Results (SEER) program from 2000-2010. Published SEER-based join-point estimates were used to extrapolate to other years. Census population data using the same age group, gender, and year strata were combined with incidence rates to project total diagnosed patient counts. The utilization module was based on SEER-Medicare linked data from 1999-2009. Drug utilization (defined as first infusion within 180 days of diagnosis for each cancer) for R+Chemo and for Chemo Alone was estimated as a proportion of all diagnosed patients, and stratified by age group, gender, and calendar year of diagnosis in the SEER-Medicare data. Utilization proportions were then multiplied by the diagnosed population counts to estimate treated patient counts for each cancer, by age group, gender, and calendar year. The survival module was calculated using SEER-Medicare data, starting from 30-days after first infusion, with follow up through 12/31/2010. For each cancer, flexible parametric (Royston-Parmar) survival models were applied to estimate restricted (10-year) mean survival times for each person, adjusted for individual patient covariates. These estimates were averaged across patients within strata defined by age group, gender and treatment. Life years lived were estimated for patients receiving R+Chemo, first by using mean survival for treatment with R+Chemo, and then by using mean survival estimates for Chemo Alone. The incremental life years saved were calculated as the difference between the projected survival from using R+Chemo and from using Chemo Alone. These differences were summed over age group, gender, and calendar year for each cancer. Monte Carlo sampling was used to estimate the 95% uncertainty intervals (UI). Results Across all three cancers, there were 289,793 cumulative life years saved (95% UI, 248,300-330,618; see Figure) from 1998 to 2013. For DLBCL, an estimated 177,952 patients were treated with R+Chemo. In these patients, an estimated 199,323 (95% UI 169,534-231,214) additional life years were lived compared to what might have occurred if Chemo Alone had been used instead. For FL, an estimated 84,303 patients were treated with R+Chemo, and an additional 80,338 (95% UI 53,876-106,709) life years were lived compared to Chemo Alone. For CLL, an estimated 14,398 patients were treated with R+Chemo, and an additional 10,132 (95% UI 4,469-15,998) life years were lived compared to Chemo Alone. Conclusions For DLBCL, FL and CLL patients treated with first-line therapy within 180 days of diagnosis in the US, approximately 290,000 cumulative life years were saved by adding rituximab to chemotherapy between 1998 and 2013. Next generation therapies may be able to extend these survival gains for patients with CLL, FL and DLBCL. Disclosures: Danese: Amgen: Consultancy, Research Funding; Genentech: Consultancy, Research Funding; Medimmune: Consultancy, Research Funding. Gleeson:Amgen, Inc.: Consultancy, Research Funding; Genentech: Consultancy, Research Funding; MedImmune: Consultancy, Research Funding. Halperin:Genentech: Consultancy, Research Funding; Medimmune: Consultancy, Research Funding; Amgen: Consultancy, Research Funding. Skettino:Genentech: Employment, stock Other. Reyes:Genentech, inc: Employment, Equity Ownership.

Long-term survival in chronic lymphocytic leukemia after first primary malignancy in the United States.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18090-e18090
Author(s):  
Amir Bista ◽  
Dipesh Uprety ◽  
Subash Ghimire ◽  
Megha Giri ◽  
Binay Kumar Shah
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Relative Survival ◽  
The United States ◽  
Lymphocytic Leukemia ◽  
Second Primary ◽  
Age Group ◽  
Primary Cancer ◽  
Primary Malignancy ◽  
Term Survival ◽  
Cancer Breast

e18090 Background: There has been significant improvement in survival among patients with primary Chronic Lymphocytic Leukemia (CLL) in recent years but, not much is known about survival among CLL developed after a first primary malignancy. Methods: SEER 18 database, 2015 submission, was used to calculate 5 and 10 year relative survival (RS) by period survival modeling method for 1993 to 2012, with division of the period into 4 cohorts of 5 years each. SEER*Stat software from National Cancer Institute was used to calculate relative survival (RS) for 4 different periods of 5 years duration. The trend in survival for cases with CLL as second primary cancer (CLLSPC) was evaluated using COX proportional hazard method using Cansurv software and also compared with that of primary CLL cases. Results: A total of 8731 patients with CLLSPC were included in the study, which represents 14.5% of all cases of CLL. The median age at diagnosis was 75 years. Median time to diagnosis of CLL was 50 months after diagnosis of first primary malignancy. Prostate cancer, breast cancer and colorectal cancer were 3most common primary cancers. 5-year and 10-year RS improved significantly in the year 2008-2012 compared to 1993-1997 (59.3% to 70.2%,P 0.044 and 40.1% to 50.6%, p 0.045). In subgroup analysis, significant improvement in 5-year and 10-year RS was seen in females and ≥ 80 years age group but no significant improvement was observed in males and age group 60-79 years. Survival among CLLSPC was significant worse compared to first primary CLL in all periods, even after adjusting for age and sex. Conclusions: CLLSPC represents about 14.5% of all CLL cases. Relative survival among patients with CLLSPC is gradually improving but still lags behind that of CLL as first primary cancer.

scholarly journals New Era in Chronic Lymphocytic Leukemia: Consequences of the Arrival of New Drugs

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4696-4696
Author(s):  
Jorge Labrador ◽  
Covadonga Garcia Diaz ◽  
Beatriz Cuevas ◽  
Maria Victoria Cuevas ◽  
Rodolfo Alvarez ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Research Funding ◽  
Statistical Significance ◽  
Young Patients ◽  
Complete Response ◽  
Cell Receptor ◽  
Advisory Board ◽  
Lymphocytic Leukemia ◽  
New Drugs ◽  
First Line

Abstract Introduction In the last decade, the incorporation of anti-CD20 monoclonal antibodies (MoAb) (rituximab, obinutuzumab), bendamustine, B-cell receptor inhibitors (ibrutinib) and Bcl-2 antagonists (venetoclax) have changed the paradigm of chronic lymphocytic leukemia (CLL) treatment, improving overall survival (OS). Methods We conducted a retrospective observational study of patients diagnosed with CLL between 2003 and 2016 at our center to evaluate: i) the influence of date of diagnosis, before or after 2010; ii) having received new drugs (MoAb or target therapies) in first line or not. Results A total of 182 patients were evaluated: 104 men (57%) and 78 women (43%); median age 74 years (39 - 97), 132 patients were &gt;65 years (72.5%). At diagnosis, 135 (74%), 19 (10%), 15 (8%), 4 (2%) and 9 (5%) were diagnosed as stages 0, I, II, II, III and IV of the Rai classification. While 154 (84%) 15 (8%) and 14 (8%) were classified as Binet's stages A, B and C. Regarding the presence of comorbidities, the median CIRS scale score was 4 (0 - 15). 71 patients (39%) were diagnosed before 2010 and 111 (61%) from 2010 onwards. With a median follow-up of 76 months (range, 20-212), 77/182 (42%) patients had received ≥1 line(s) of treatment: 1: 53%, 2: 26%, 3: 8%, ≥4: 13%. 20 patients (26%) received the first line of treatment before 2010, and 56 (74%) from 2010 onwards. Half of the patients received new drugs in 1st line (n=39), 92% of them from 2010 onwards. 32 patients (41.5%) achieved complete response after 1st line, and 24 (31%) at least a partial response. The median OS of patients diagnosed before 2010 was 66 months (35.32 - 96.68) vs 143 months (95% CI 90.5 - 195.5) (p=0.032) as of 2010. In those ≤ 65 years median OS has not been reached, being 80.5% at 10 years: 65% for those diagnosed before 2010 and 97% after 2010, p=0.036. The median OS of patients &gt; 65 years was 6 years (95% CI 4.17 - 7.83), and increased from 82 months for those diagnosed before 2010, to 110 months in those diagnosed after 2010, p=0.744. Patients treated with new drugs in 1st line increased the median OS from 76 months and 13% at 10 years to a median not reached and OS of 77% at 10 years, p=0.000. This difference was more evident in those ≤ 65 years: 20% vs 100% at 10 years (p=0.012), while it was not statistically significant for those &gt; 65 years (11% vs 50% at 10 years, p=0.181) (Figure 1). However, in a multivariate model including age, sex, CIRS&gt;6 and year of diagnosis (before or after 2010), treatment with new drugs retained statistical significance (HR 0.414; 95% CI 0.183 - 0.935) along with age ≤ 65 years (HR 0.256; 95% CI 0.085 - 0.771) and CIRS ≤ 6 (HR 0.247; 95% CI 0.111 - 0.551). Conclusions In our experience, the introduction of new drugs in the first line has led to an increase in OS, especially in young patients. Figure 1 Figure 1. Disclosures Gonzalez-Lopez: Grifols: Other: Advisory board honoraria; Sobi: Other: Advisory board honoraria; Amgen: Other: Advisory board and speakers honoraria, Research Funding; Novartis: Other: Advisoryboard and speakers honoraria, Research Funding.

Mutations in TLR/MYD88 pathway identify a subset of young chronic lymphocytic leukemia patients with favorable outcome

Blood ◽  
2014 ◽  
Vol 123 (24) ◽  
pp. 3790-3796 ◽  
Author(s):  
Alejandra Martínez-Trillos ◽  
Magda Pinyol ◽  
Alba Navarro ◽  
Marta Aymerich ◽  
Pedro Jares ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Young Patients ◽  
Lymphocytic Leukemia ◽  
Favorable Outcome ◽  
Healthy Population ◽  
Age And Gender ◽  
Good Outcome ◽  
Key Points ◽  
And Gender ◽  
Myd88 Pathway

Key Points Mutations in the TLR/MYD88 pathway occur in 4% of patients with CLL, and they are the most frequent in young patients. TLR/MYD88 mutations in CLL patients confer a good outcome, which is similar to that of the age- and gender-matched healthy population.

scholarly journals Economic Burden of Chronic Lymphocytic Leukemia in the Era of Oral Targeted Therapies in the United States

2017 ◽  
Vol 35 (2) ◽  
pp. 166-174 ◽  
Author(s):  
Qiushi Chen ◽  
Nitin Jain ◽  
Turgay Ayer ◽  
William G. Wierda ◽  
Christopher R. Flowers ◽  
...  
Keyword(s):  
United States ◽  
Chronic Lymphocytic Leukemia ◽  
Targeted Therapies ◽  
Standard Of Care ◽  
The United States ◽  
Lymphocytic Leukemia ◽  
Significant Advance ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

Purpose Oral targeted therapies represent a significant advance for the treatment of patients with chronic lymphocytic leukemia (CLL); however, their high cost has raised concerns about affordability and the economic impact on society. Our objective was to project the future prevalence and cost burden of CLL in the era of oral targeted therapies in the United States. Methods We developed a simulation model that evaluated the evolving management of CLL from 2011 to 2025: chemoimmunotherapy (CIT) as the standard of care before 2014, oral targeted therapies for patients with del(17p) and relapsed CLL from 2014, and for first-line treatment from 2016 onward. A comparator scenario also was simulated where CIT remained the standard of care throughout. Disease progression and survival parameters for each therapy were based on published clinical trials. Results The number of people living with CLL in the United States is projected to increase from 128,000 in 2011 to 199,000 by 2025 (55% increase) due to improved survival; meanwhile, the annual cost of CLL management will increase from $0.74 billion to $5.13 billion (590% increase). The per-patient lifetime cost of CLL treatment will increase from $147,000 to $604,000 (310% increase) as oral targeted therapies become the first-line treatment. For patients enrolled in Medicare, the corresponding total out-of-pocket cost will increase from $9,200 to $57,000 (520% increase). Compared with the CIT scenario, oral targeted therapies resulted in an incremental cost-effectiveness ratio of $189,000 per quality-adjusted life-year. Conclusion The increased benefit and cost of oral targeted therapies is projected to enhance CLL survivorship but can impose a substantial financial burden on both patients and payers. More sustainable pricing strategies for targeted therapies are needed to avoid financial toxicity to patients.

Prevalence Estimates of Adult Chronic Idiopathic Thrombocytopenic Purpura (ITP) in the United States.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3202-3202 ◽  
Author(s):  
Maurilee A. Feudjo-Tepie ◽  
Noah J. Robinson ◽  
Dimitri Bennett
Keyword(s):  
Large Data ◽  
The United States ◽  
Published Data ◽  
Age Group ◽  
Data Set ◽  
Age And Gender ◽  
Chronic Itp ◽  
Prevalence Estimates ◽  
The Us ◽  
And Gender

Abstract ITP is a disease caused by inadequate platelet production as well as increased platelet destruction. Literature on the epidemiology of ITP is currently sparse and the disease remains poorly described. Based on previous reviews, the overall incidence of ITP among adults ranges from 1.6 to 3.0 per 100,000 person years of observation (PYO); prevalence estimates range from 2.1 to approximately 36.4 per 100,000 persons (Neylon AJ et al., Br J Haematol. 2003; Satia J et al., Eur Hematol Assoc. [poster presentation] 2006; Deitz AC et al., Blood. 2006). In this study, the objective was to estimate the prevalence of adult chronic ITP (in 2005) stratified by age and gender using a large US claims database (Integrated Healthcare Information Services, IHCIS). IHCIS comprises over 70 million patients from 45 health plans. Adult chronic ITP cases were defined as patients with at least two diagnoses (ICD-9 code 287.3) for primary thrombocytopenia separated by at least 6 months between 2002 and 2006, and age 18 or older in 2004. Although ICD-9 code 287.3 is not exclusive to ITP, its sensitivity and specificity are likely to be high (Segal et al., Am J Hem. 2004). A patient’s first identified 287.3 ICD-9 code over the period 2002–2006 had to be in 2004 or earlier and the last one in 2004 or later. Patients had to have continuous enrollment throughout the year 2004. We estimated the 2004 prevalence as the total number of identified chronic ITP cases divided by the total population in the database in 2004 stratified by age group and gender. Estimates of adult cases for the US population were obtained by multiplying the 2004 prevalence estimates by the 2005 adult US census population estimates. The estimated adult prevalence was 23.6 [95% CI 23.4 – 23.8] per 100,000 persons, translating to approximately 52,700 (95% CI 52,200 – 53,100) adult chronic ITP cases in the US. Females had higher prevalence than males (28.1 vs 18.8 per 100,000). In addition, prevalence increased with age (from 17.0 in the age group 18–49 to 36.2 in the age group 65 and older). These results are broadly similar to previously published data and help to better understand the epidemiology of chronic ITP. While the tight CIs predominantly reflect the large data set rather than the precision of the estimates, we believe these data are among the most robust estimates of ITP prevalence and are the first to specifically estimate adult chronic ITP prevalence by age and gender in the US.

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