Chronic lymphocytic leukemia (CLL)-related mortality is significantly higher in patients aged 75 years or older, prompting a need for novel treatment options, according to a study published in BMC Cancer (2017;17[1]:198).
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Most diagnoses of CLL occur in people aged 75 years or older. However, most clinical trials for CLL enroll younger patients, thus not reflecting the demographics of people with CLL in the real-world.
Researchers from various US health centers conducted the largest comprehensive prospective evaluation of treatment patterns, outcomes, and disease-related mortality in patients aged 75 years or older with CLL in the real-world. Patient data — received from the Connect CLL registry — included 1494 adult samples between 2010 and 2014. Of this sample, 259 older patients were enrolled within 2 months of starting first-line of therapy and 196 older patients were enrolled in a subsequent line of therapy.
Results of the evaluation showed that older patients with CLL were more likely to receive rituximab monotherapy and chemotherapy-alone regimens compared with younger patients (19.3% vs 8.6%, respectively). When given similar regimens, overall and complete response rates were lower in the older population than the younger population. After a median follow-up of 3 years, CLL-related deaths were higher in the older population than the younger population in the first-line of therapy group (12.6% vs 5.1%) and the subsequent line of therapy group (31.3% vs 21.5%).
Additionally, infection-related deaths were also higher in the older population than the younger population in the first-line of therapy group (7.4% vs 2.7%) and the subsequent line of therapy group (16.2% vs 11.2%).
Researchers were able to form a prognostic score for older patients with CLL; time from diagnosis to treatment <3 months, enrollment therapy other than bendamustine or rituximab, and anemia all are considered identifiable factors for older patients at higher risk of CLL-related mortality.
Higher mortality rates in older patients with CLL highlight the “urgent need for alternative treatment strategies for these understudied patients,” wrote the authors of the study. — Zachary Bessette
