The Economic Burden of Tumor Lysis Syndrome in Patients With Chronic Lymphocytic Leukemia

Kerry Rogers, MD, Division of Hematology, The Ohio State University, Columbus led a study analyzing tumor lysis syndrome (TLS)-associated health care resource utilization and costs among patients with chronic lymphocytic leukemia and small lymphocytic lymphoma who were treated with regimens associated with a high TLS risk.

Transcript

Hi, I'm Kerry Rogers. I'm an associate professor in the Division of Hematology at the Ohio State University. And I'm going to tell you a little bit about a project that we published recently, which was a collaboration with Janssen. And this was looking at the clinical and economic burden of tumor lysis syndrome in CLL patients undergoing treatment. It was actually a really cool study because this used market scan data to look at patients getting treatment. And we looked at regimens that were previously reported in guidelines to be associated with a risk for tumor lysis, which included chemo, immunotherapy, obinutuzumab, and of course, venetoclax, among some others. And then looked at time after initiation of treatment in kind of time segments and looked at patients that developed tumor lysis syndrome.

And there were a couple different ways to ascertain that, and healthcare costs associated with developing tumor lysis syndrome. And it was kind of for that time period, that was the time period in which they developed it, just to look at kind of what the economic burden was of this. So, as many people know, venetoclax, which is an extremely useful drug in chronic lymphocytic leukemia, has a high risk for this very acute tumor lysis syndrome, which can be a major barrier for using the drug safely. And the prescribing information specifies a risk mitigation strategy to both monitor and also dose increase over about five weeks or over exactly five weeks to decrease the risk of having really acute tumor lysis from going to the target dose immediately. And also there's laboratory monitoring visits and inpatient hospitalizations for this.

So, this is burdensome for patients and also costly, so I do think it's important to look at that relative to the cost of actually developing tumor lysis syndrome. Unsurprisingly, there were higher costs associated with episodes where people, or time periods where people had tumor lysis syndrome after implementing treatments. And a lot of this was driven by higher inpatient costs, which is not surprising. So, this is actually something that does matter to our patients is that tumor lysis syndrome is costly. So, the risk reduction schemes are worthwhile, even though those also require more resource utilization. And just any strategies really to decrease the risk of tumor lysis syndrome would probably be beneficial for our patients.

I also want to point out that more patients had to change therapy for their CLL after developing tumor lysis syndrome, which should be kind of obvious that patients may be experiencing that type of toxicity, wouldn't continue with that treatment. So, that's just a further reason that these mitigation strategies are actually very helpful.

So, this was a fun study to be a part of, even though the findings might seem obvious, and that's tumor lysis syndrome is costly. I think it remains very important to do this type of analysis to really understand this aspect of CLL care, so I really enjoyed working with my collaborators at Janssen on this project. And I would like to thank all of you for your attention.