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Review
. 2021 Nov 21;3(1):291-300.
doi: 10.1002/jha2.322. eCollection 2022 Feb.

Characterization of real-world treatment practices and outcomes among patients with chronic lymphocytic leukemia treated in a Finnish tertiary center

Juha Ranti  1 , Katariina Perkonoja  2 , Tommi Kauko  2 , Heidi Loponen  3 , Emmi I Joensuu  3 , Tiina M Järvinen  4
Affiliations
Review

Characterization of real-world treatment practices and outcomes among patients with chronic lymphocytic leukemia treated in a Finnish tertiary center

Juha Ranti et al. EJHaem. .

Abstract

Objectives: We conducted this retrospective study to characterize the change in chronic lymphocytic leukemia (CLL) treatment patterns between 2005 and 2019, to understand the treatment sequencing across the course of the disease, and to investigate how targeted agents and prognostic testing were implemented into the patient care.

Methods: This study included adult patients with CLL treated at the Hospital District of Southwest Finland during the study period. Data were collected from the Turku University Hospital data lake.

Results: In total, 122 and 60 patients received first- and second-line treatments for CLL, respectively. The shift from conventional chemoimmunotherapy to targeted treatments in recent years (2014-2019) was observed. The median overall survival times were not reached in patients treated with targeted agents compared to conventional standard treatments in first- and second-line settings and improved toward the end of the study period. Prognostic testing increased during the study follow-up and patients with unmutated immunoglobulin heavy-chain variable showed significantly poorer overall survival and time-to-next-treatment outcomes than patients with mutated immunoglobulin heavy-chain variable.

Conclusions: This real-world study implicated added value of targeted chemo-free therapies as reported in randomized clinical trials, and highlighted the necessity of prognostic testing in order to improve treatment selection and patient outcomes.

Keywords: IGHV; chemoimmunotherapy; chronic lymphocytic leukemia; survival; targeted therapy.

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Conflict of interest statement

Juha Ranti served as a consultant for Janssen, AbbVie, and AstraZeneca, on the speakers' bureau for AbbVie and received travel support from Janssen and AbbVie. Katariina Perkonoja and Tommi Kauko are present or previous employees of Auria Clinical Informatics serving both academic research and industry‐sponsored scientific studies. Heidi Loponen and Emmi I. Joensuu are employees of MedEngine Oy. Tiina M. Järvinen is an employee of Janssen‐Cilag Oy.

Figures

FIGURE 1
FIGURE 1
First‐, second‐, and third‐line treatments during 2005–2013 and 2014–2019. Percentages of treatment regimens used during 2005–2013 and 2014–2019
FIGURE 2
FIGURE 2
Treatment sequencing during the study period (2005–2019). Sunburst plot illustrating treatment sequencing across treatment lines. The innermost circle represents the first‐line treatment. The white boxes indicate the number of patients (n < 5) and percentages for the respective colored sectors not labeled in the plot
FIGURE 3
FIGURE 3
Kaplan‐Meier survival curves for overall survival (OS) and time‐to‐next‐treatment (TTNT) for targeted or standard of care therapies in the first‐ and second‐line treatments. (A) OS and (B) TTNT in first‐line treatment (C) OS and (D) TTNT in second‐line treatment. Targeted therapies: ibrutinib, idelalisib, or venetoclax (monotherapy or in combination); standard of care (SOC) therapies: any other therapy. Statistical comparisons were not conducted due to the small sample size in the targeted group
FIGURE 4
FIGURE 4
Kaplan‐Meier survival curves for overall survival (OS) and time‐to‐next‐treatment (TTNT) in first and second‐line treatments during 2005–2013 and 2014–2019. (A) OS (log‐rank p‐value = 0.872) and (B) TTNT (log‐rank p‐value = 0.106) in first‐line treatment, (C) OS (log‐rank p‐value = 0.151) and (D) TTNT (log‐rank p‐value = 0.459) in second‐line treatment
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