PMID- 36205521
OWN - NLM
STAT- MEDLINE
DCOM- 20221207
LR  - 20221226
IS  - 1473-4877 (Electronic)
IS  - 0300-7995 (Linking)
VI  - 38
IP  - 12
DP  - 2022 Dec
TI  - Clinical and economic burden of first-line chemoimmunotherapy by risk status in 
      chronic lymphocytic leukemia.
PG  - 2149-2161
LID - 10.1080/03007995.2022.2133468 [doi]
AB  - OBJECTIVES: To evaluate the trend in cytogenetic/molecular testing rate in 
      chronic lymphocytic leukemia (CLL) and assess the clinical and economic burden of 
      first-line (1 L) treatment with chemoimmunotherapy (CIT) by risk status. METHODS: 
      This retrospective cohort study identified patients with CLL from a U.S. managed 
      care population. Medical records were obtained for eligible patients who 
      initiated 1 L CIT between 1/1/2007 and 7/31/2019 and underwent prognostic testing 
      to classify them as high risk (del(17p), TP53 mutation, del(11q), unmutated IGHV 
      or complex karyotype) or as non-high risk by FISH only (non-del(17p) and 
      non-del(11q)). Study outcomes included testing rate, time to next treatment 
      (TTNT) or death, time to treatment failure (defined as time to change of therapy, 
      non-chemotherapy intervention, hospice care or death), and total plan paid costs 
      (medical + pharmacy) per patient per month (PPPM) in the 1 L period. Cox 
      proportional hazard models and generalized linear models were used to calculate 
      adjusted hazard ratio or rate ratio. RESULTS: Among the 1,808 patients with CLL, 
      612 were FISH or IGHV tested and the rate of testing increased from 30% to 44% 
      from 2007-2019. High-risk patients (n = 119) had 65% higher risk of next 
      treatment or death (median time: 2.4 vs 3.7 years), 65% higher risk of treatment 
      failure (median time: 3.0 vs 4.9 years), and 33% higher costs ($12,194 vs $9,055, 
      p = 0.027) during 1 L treatment than non-high risk patients (n = 134). 
      CONCLUSIONS: High-risk CLL patients treated with 1 L chemoimmunotherapy have 
      poorer clinical and economic outcomes compared to non-high risk patients. 
      Assessment of genetic risk remains suboptimal.
FAU - Leslie, Lori A
AU  - Leslie LA
AUID- ORCID: 0000-0002-7265-4076
AD  - John Theurer Cancer Center, Hackensack, NJ, USA.
FAU - Gangan, Nilesh
AU  - Gangan N
AUID- ORCID: 0000-0001-6581-7239
AD  - HealthCore Inc, Wilmington, DE, USA.
FAU - Tan, Hiangkiat
AU  - Tan H
AUID- ORCID: 0000-0002-1960-1493
AD  - HealthCore Inc, Wilmington, DE, USA.
FAU - Huang, Qing
AU  - Huang Q
AD  - Janssen Scientific Affairs, LLC, Horsham, PA, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20221022
PL  - England
TA  - Curr Med Res Opin
JT  - Current medical research and opinion
JID - 0351014
SB  - IM
MH  - Humans
MH  - *Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
MH  - Retrospective Studies
MH  - Financial Stress
MH  - Immunotherapy
MH  - Prognosis
MH  - Mutation
OTO - NOTNLM
OT  - Chronic lymphocytic leukemia
OT  - IGHV
OT  - chemoimmunotherapy
OT  - cytogenetic risk assessment
OT  - del(11q)
OT  - del(17p)
EDAT- 2022/10/08 06:00
MHDA- 2022/12/27 06:00
CRDT- 2022/10/07 09:43
PHST- 2022/10/08 06:00 [pubmed]
PHST- 2022/12/27 06:00 [medline]
PHST- 2022/10/07 09:43 [entrez]
AID - 10.1080/03007995.2022.2133468 [doi]
PST - ppublish
SO  - Curr Med Res Opin. 2022 Dec;38(12):2149-2161. doi: 10.1080/03007995.2022.2133468. 
      Epub 2022 Oct 22.