Real-world analysis of treatment patterns and clinical outcomes in patients with newly diagnosed chronic lymphocytic leukemia from seven Latin American countries

• Published in: Hematology (Luxembourg) Vol. 25; no. 1; pp. 366 - 371
• Main Authors: Chiattone, Carlos, Gomez-Almaguer, David, Pavlovsky, Carolina, Tuna-Aguilar, Elena J., Basquiera, Ana L., Palmer, Luis, de Farias, Danielle Leao Cordeiro, da Silva Araujo, Sergio Schusterschitz, Galvez-Cardenas, Kenny Mauricio, Gomez Diaz, Alvaro, Lin, Jennifer H., Chen, Yen-wen, Machnicki, Gerardo, Mahler, Michelle, Parisi, Lori, Barreyro, Paula
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.01.2020
• Subjects: Age Factors; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; chlorambucil; chronic lymphocytic leukemia; Disease-Free Survival; Female; fludarabine; Humans; Latin America; Latin America - epidemiology; Leukemia, Lymphocytic, Chronic, B-Cell - diagnosis; Leukemia, Lymphocytic, Chronic, B-Cell - drug therapy; Leukemia, Lymphocytic, Chronic, B-Cell - mortality; Male; Middle Aged; overall survival; progression-free survival; real-world evidence; Risk Factors; Survival Rate; treatment pattern; Latin America; chronic lymphocytic leukemia; real-world evidence; progression-free survival; fludarabine; overall survival; chlorambucil; treatment pattern; Latin America
• ISSN: 1607-8454; 1607-8454
• DOI: 10.1080/16078454.2020.1833504

To describe chronic lymphocytic leukemia (CLL) treatment patterns and patient outcomes in Latin America. This chart review study (NCT02559583; 2008-2015)evaluated time to progression (TTP) and overall survival (OS) outcomes among patients with CLL who initiate done (n = 261) to two (n = 96) lines of therapy (LOT) since diagnosis. Differences in TTP and OS were assessed by Kaplan-Meier analysis, with a log-rank test for statistical significance. Association between therapeutic regimen and risk for disease progression or death was estimated using Cox proportional hazard regression. The most commonly prescribed therapies in both LOTs were chlorambucil-, followed by fludarabine- and cyclophosphamide (C)/CHOP-based therapies. Chlorambucil- and C/CHOP-based therapies were largely prescribed to elderly patients (≥65 years) while fludarabine-based therapy was predominantly used by younger patients (≤65 years). In LOT1, relative to chlorambucil-administered patients, those prescribed fludarabine-based therapies had lower risk of disease progression (hazard ratio [HR] and 95% confidence interval [CI] 0.32 [0.19-0.54]), whereas C/CHOP-prescribed patients had higher risk (HR 95%CI 1.88 [1.17-3.04]). Similar results were observed in LOT2. There was no difference in OS between treatments in both LOTs. Novel therapies such as kinase inhibitors were rarely prescribed in LOT1 or LOT2in Latin America. The greater TTP observed forfludarabine-based therapies could be attributed to the fact that fludarabine-based therapies are predominantly administered to young and healthy patients. Chlorambucil-based therapy, which has limited benefits, is frequently prescribed in Latin America. Prescribing novel agents for fludarabine-based therapy-ineligible patients with CLL is the need of the hour. Trial registration: ClinicalTrials.gov identifier: NCT02559583.