Lori A. Leslie, M.D.
Director of the Indolent Lymphoma and Chronic Lymphocytic Leukemia (CLL) Research Programs, John Theurer Cancer Center at Hackensack University Medical Center
Updated: November 16, 2022
Lori A. Leslie, M.D., director of the indolent lymphoma and chronic lymphocytic leukemia (CLL) research programs at Hackensack University Medical Center’s John Theurer Cancer Center, a part of Georgetown Lombardi Comprehensive Cancer Center, is the lead author of a recent paper focusing on the clinical and economic burdens faced by patients with high-risk CLL.
The paper, published in Current Medical Research and Opinion, demonstrates that, compared to non-high-risk patients, those with high-risk CLL who are treated with first-line chemoimmunotherapy (CIT) have worse clinical and economic outcomes, including greater risk of next treatment or death, higher risk of treatment failure, and greater economic burdens.
“The availability of prognostic testing is enabling more precise risk-stratification of patients with CLL, and our findings validate the association between higher risk and worse outcomes,” said Dr. Leslie. “Yet despite recent advances in testing technologies, assessment of genetic risk remains suboptimal. We hope our study results spur more widespread adoption of cytogenic and molecular testing in patients with CLL and other malignancies, as well as greater awareness of the clinical and economic implications of high-risk disease.”
About the Study
Dr. Leslie and colleagues conducted a retrospective cohort study to evaluate the trend in cytogenic/molecular testing rates in CLL, and to assess the clinical and economic burden of first-line treatment with CIT by risk status. They identified patients with CLL from a U.S. managed care population, and obtained medical records from eligible patients who initiated first-line CIT between January 1, 2007 and July 31, 2019. The patients underwent prognostic testing to classify them as high-risk (via immunoglobulin heavy-chain variable region gene [IGHV] testing) or non-high-risk (by fluorescence in situ hybridization [FISH]).
Among the 1,808 patients with CLL, 612 were tested via FISH or IGHV, and the rate of testing increased from 30% to 44% from 2007 to 2019. High-risk patients (n = 119) had a 65% higher risk of next treatment or death (median time: 2.4 vs. 3.7 years), a 65% higher risk of treatment failure (defined as time to change of therapy, non-chemotherapy intervention, hospice care, or death; median time: 3.0 vs. 4.9 years), and 33% higher medical and pharmacy costs ($12,194 vs. $9,055 per patient per month, P = 0.027) during first-line treatment, compared to non-high-risk patients (n = 134).