Quality of Life Care in Chronic Lymphocytic Leukemia Patients

San Diego—A prospective, longitudinal, observational study found that the health-related quality of life (HRQOL) in patients with chronic lymphocytic leukemia (CLL) did not differ based on age. In addition, the most common type of first-line treatment for all patients was the combination of fludarabine, cyclophosphamide, and rituximab (FCR), although the use of that regimen decreased as patients got older. Results were presented in a poster session at the ASH meeting. The Connect Chronic Lymphocytic Leukemia Disease Registry began in March 2010 and involves approximately 200 investigators who plan on enrolling approximately 1500 patients. The inclusion criteria included patients ≥18 years of age with clinically diagnosed CLL who began first-line, second-line, or subsequent line treatment within 2 months of entering the study. The study enrolled 607 patients from 161 centers in the United States: 198 were <65 years of age, 187 were between 65 and 74 years of age, and 222 were >74 years of age. Of all the patients, 62% were males, 90% were white, and the mean age was 69.4 years. In a poster titled Variation in Health-Related Quality of Life by Age among Patients with Chronic Lymphocytic Leukemia, clinicians reported the patient demographics and clinical characteristics, while patients self-reported HRQOL. Patients also completed the EQ-5D health outcomes measurement tool, the Brief Fatigue Inventory (BFI), and the Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu). The EQ-5D measures HRQOL on a visual analog scale (VAS) and across 5 domains. The authors found there were no statistically significant HRQOL differences in the age groups when measured by the BFI or EQ-5D VAS. They also concluded that anxiety/depression and self-care did not vary by age. However, patients between 65 and 74 years of age scored significantly better in the mobility, usual activities, and pain/discomfort domains compared with the younger and older groups. The authors suggested that further analysis should focus on ways HRQOL is influenced by alternative therapies and disease symptoms and affected over time based on disease changes. In a related poster titled Patterns of Care for Patients with Chronic Lymphocytic Leukemia (CLL): The Connect CLL Disease Registry, the authors examined the treatment strategies based on the patients’ ages. The analysis included 496 patients who had initiated therapy. FCR was the most common first-line therapy, occurring in 33% of all patients, including 46% of patients <65 years of age, 32% of patients between 65 and 74 years of age, and 20% of patients >74 years of age. Other popular first-line therapies included bendamustine-based (19%), fludarabine-based with or without rituximab (15%), investigational therapy (15%), and chlorambucil with or without steroids (6%). The most common therapy used in subsequent lines was bendamustine-based (30% of patients), followed by FCR (23%), fludarabine-based with or without rituximab (13%), investigational therapy (8%), and chlorambucil with or without steroids (3%). The authors noted that they were surprised at the number of patients who received investigational agents as first-line or subsequent line therapy, which exceeded their expectations. The study further examined the type of therapy based on Eastern Cooperative Oncology Group (ECOG) performance status score. In the <65 years of age group, the treatment regimen did not vary based on ECOG score. However, in the 65 to 74 years of age group and >74 years of age group, patients with an ECOG score of 0 were most often assigned to FCR-based first-line therapy. Meanwhile, for patients in those 2 groups who had an ECOG score ≥1, the most common first-line therapy was bendamustine-based. These studies were funded by Celgene Corporation.