Limited value of routine follow-up visits in chronic lymphocytic leukemia managed initially by watch and wait: A North Denmark population-based study

• Published in: PloS one Vol. 13; no. 12; p. e0208180
• Main Authors: Nørgaard, Caroline Holm, Søgaard, Nikoline Buus, Biccler, Jorne Lionel, Pilgaard, Laura, Eskesen, Mathias Holmsgaard, Kjartansdottir, Thordis Helga, Bøgsted, Martin, El-Galaly, Tarec Christoffer
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 27.12.2018; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Aged, 80 and over; Biology and Life Sciences; Blood; Blood tests; Cancer; Care and treatment; Chronic lymphocytic leukemia; Clinical medicine; Cytogenetics; Denmark; Diagnosis; Female; Follow-Up Studies; Hematology; Hemoglobin; Hospitals; Humans; Immunoglobulins; Laboratories; Leukemia; Leukemia, Lymphocytic, Chronic, B-Cell - diagnosis; Leukemia, Lymphocytic, Chronic, B-Cell - pathology; Leukemia, Lymphocytic, Chronic, B-Cell - therapy; Lymphatic leukemia; Lymphatic system; Male; Medical diagnosis; Medical research; Medicine and Health Sciences; Middle Aged; Neoplasm Staging; Office Visits - statistics & numerical data; Office Visits - trends; Patients; Population studies; Population-based studies; Prognosis; Quality of life; Regression models; Risk allocation; Risk Factors; Risk groups; Statistical analysis; Studies; Survival analysis; Systematic review; Time-to-Treatment - statistics & numerical data; Time-to-Treatment - trends; Variables; Watchful Waiting; Denmark
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0208180

The majority of newly diagnosed chronic lymphocytic leukemia (CLL) patients are followed initially by watch and wait (WAW). Clinical practice varies and the value of frequent follow-up visits remains unclear. Thus, in this study we investigated the clinical value of follow-up visits for patients with CLL. We collected data from diagnosis and follow-up visits for patients diagnosed with CLL and managed by WAW in the North Denmark Region between 2007-2014. High- and low-risk group patients were determined by Binet stage, IgVH status, and cytogenetics at diagnosis. The effect of risk group allocation on the probability of receiving CLL-directed treatment within two years was included in a multivariable logistic regression model adjusted for age and blood test results. 273 patients were included in the study with a median follow-up of 3 years (IQR: 1.6-5.4). Overall, the median interval between follow-up visits was 98 days (95% CI: 96-100) (high-risk patients: 91 days [95% CI: 86-95] vs. low-risk patients: 105 days [95% CI: 100-110]). Among 2,312 follow-up visits, only 387 (17%) were associated with interventions. At the following time points: 6 months, 1 year, and 1.5 years, patients with low-risk CLL had significantly lower odds of initiating treatment compared to patients with high-risk CLL. WAW plays an important role in managing CLL. Interventions at follow-up visits were infrequent and low-risk patients had significantly lower risk of treatment initiation. We question the value of routine follow-up in CLL in the absence of changes in symptoms and/or blood test results.