Acalabrutinib monotherapy versus acalabrutinib plus obinutuzumab combination therapy in treatment-naïve chronic lymphocytic leukemia: a ‘real-world’ study of efficacy and safety at a tertiary academic medical center. In this retrospective study, researchers compared the efficacy and safety of acalabrutinib monotherapy and acalabrutinib plus obinutuzumab as first-line treatment for chronic lymphocytic leukemia (CLL). Baseline characteristics were similar between patients treated with acalabrutinib monotherapy (n=21) and those treated with combination therapy (n=60). In the combination therapy group, Grade ≥3 adverse events (AEs) were reported in 56.7% of patients, compared to 38.1% in the acalabrutinib monotherapy group. Other toxicities, including bleeding (35.0% vs 23.8%) and cardiac events (23.3% vs 9.5%), were more common in the combination therapy group compared to the acalabrutinib monotherapy group. Ten percent of patients treated with acalabrutinib plus obinutuzumab experienced infusion-related reactions. A comparable proportion of patients treated with acalabrutinib monotherapy and acalabrutinib plus obinutuzumab experienced dose modifications due to AEs (57.1% and 60.0%, respectively). Complete response was achieved by 80.0% of patients in the combination therapy group and 19.0% of patients in the acalabrutinib monotherapy group, while partial response was reached by 16.7% and 61.9%, respectively. Progression-free survival (PFS) and overall survival (OS) rates were high in both groups; at median follow-up of 25 months, PFS and OS rates were 88.3% and 95%, respectively, in the acalabrutinib plus obinutuzumab group and 85.7% and 81%, respectively, in the acalabrutinib monotherapy group. These findings show that acalabrutinib monotherapy and combination therapy are both effective first-line treatments for CLL, and acalabrutinib monotherapy might be a more viable treatment option for patients at greater risk for toxicities.
Access abstract here: https://ashpublications.org/blood/article/146/Supplement%201/4558/553200/Acalabrutinib-monotherapy-versus-acalabrutinib
Suboptimal cancer-screening adherence in patients with CLL/SLL. The risk of second primary malignancy is increased in patients with CLL/small lymphocytic lymphoma (SLL). In this retrospective study, researchers assessed the rate of screenings for colorectal and breast cancers among patients with CLL/SLL. Data from the TriNetX Research Network were utilized for analysis, and patients aged 50 to 75 years with at least one health encounter were included. Among 36,475 women with CLL/SLL, 7,158 underwent screening mammography, which corresponded to a compliance rate of about 20%. The risk of diagnosis of malignant neoplasm of the breast was 7.8% among patients who were screened, compared to 6.2% of patients who did not undergo screening mammography. After adjusting for confounding factors, OS was significantly improved in patients who had undergone screening (p<0.0001). Compliance with colorectal cancer screening was lower than that of breast cancer; 11,232 of 92,728 patients had undergone colonoscopy, which corresponded to a compliance rate of about 12%. The risk of developing colon cancer was similar among screened (1.9%) and unscreened (1.3%) patients. Patients who underwent colonoscopy had significantly increased OS compared to those who did not undergo colonoscopy (p<0.0001). These findings highlight the need for improved adherence to cancer screenings among patients with CLL/SLL.
Access abstract here: https://ashpublications.org/blood/article/146/Supplement%201/4536/556619/Suboptimal-cancer-screening-adherence-in-CLL-SLL
A tale of two settings: survival disparities in CLL/SLL between academic and community cancer programs in the US National Cancer Database. In this retrospective analysis, researchers compared differences in treatment pattern and survival outcomes among patients with CLL/SLL treated at academic (ACPs) and community cancer programs (CCPs). Data from 2004 to 2022 were evaluated. A total of 102,545 patients treated at ACPs and 97,704 treated at CCPs were included for analysis. Compared to CCPs, ACPs had a higher proportion of Black (9.2% vs 6.3%) and Hispanic (3.4% vs 2.3%) patients. Patient age significantly differed between groups (p<0.001); patients aged <60 years were more commonly treated at ACPs (23.1% vs 18.6% at CCPs), whereas those aged ≥75 years were commonly treated at CCPs (37.4% vs 31.9% at ACPs). In the ACP group, 8.5% of patients had a Charlson-Deyo score ≥2 compared to 7.9% of those in the CCP group (p=0.006). Median travel distance was longer in the ACP group compared to the CCP group (10.2 vs 7.5 miles, p<0.001). Watchful waiting treatment plans were employed more frequently at ACPs (37.6%) than CCPs (33.0%), while no treatment was more common at CCPs compared to ACPs (20.9% vs. 17.2%, p<0.001). The rate of systematic therapy was similar between groups (ACP: 19.4%; CCP: 19.3%). Median time to treatment (including prescription, systemic therapy, chemotherapy, and immunotherapy) was longer at ACPs (all p≤0.004). Estimated 2-, 5-, and 10-years OS rates were 84.3%, 69.1%, and 47.8%, respectively, at ACPs and 84.4%, 68.3%, and 46.1%, respectively, at CCPs (p<0.001). Treatment at an ACP was significantly associated with improved OS, according to multivariable analysis (hazard ratio [HR]: 0.95; 95% confidence interval [CI]: 0.93–0.97, p<0.001).
Access abstract here: https://ashpublications.org/blood/article/146/Supplement%201/4403/549019/A-tale-of-two-settings-Survival-disparities-in-CLL
Progression of disease within 36 months (POD36) of starting first-line targeted therapy independently predicts poor overall survival in patients with chronic lymphocytic leukemia (CLL). Progression within 24 months of chemoimmunotherapy is a poor prognostic factor for CLL, but the prognostic impact of early progression on targeted therapy is unclear. Researchers compared survival outcomes among patients who received first-line targeted therapy who experienced progressive disease within 36 months of treatment initiation (POD36) and patients without early progression. A total of 787 patients were included for analysis. Median age at treatment initiation was 67 years, and 67% of patients were male. Of 519 patients with CLL-IPI data, 44% and 15% had high- and very high–risk scores, respectively. At median follow-up of 50 months, 496 patients met the criteria for defining POD36; of these patients, 72 (15%) experienced PD. Univariate analysis showed that TP53 disruption, defined as TP53 mutation or del17p, was associated with POD36 (odds ratio [OR]: 2.9; 95% CI: 1.5–5.7; p=0.001). Patients with POD36 had significantly shorter OS compared to patients without POD36 (HR: 3.5; 95% CI: 2.1–6.0; p<0.0001). Estimated 4-year OS rate was 65% in the POD36 group and 88% in the non-POD36 group. Landmark analysis of patients still alive at 3 years post-treatment initiation also showed that OS was significantly decreased in patients with POD36 (n=50) compared to those without POD36 (HR: 3.5; 95% CI: 1.8–6.8; p=0.0002). In the overall cohort (n=787), multivariable analysis showed a significant association between POD36 and decreased OS (HR: 4.2; 95% CI: 2.1–8.4; p<0.0001).
Access abstract here: https://ashpublications.org/blood/article/146/Supplement%201/5667/556213/Progression-of-disease-within-36-months-POD36-of
Nodal progression in CLL: real-world predictors of Richter transformation and identification of a distinct high-risk NP-CLL subgroup. The aim of this study was to identify real-world predictors of Richter transformation (RT) in CLL. Patients with CLL who underwent positron emission tomography-computed tomography (PET-CT) and biopsy within 3 months to evaluate possible RT were eligible for inclusion. A total of 249 patients were included for analysis. Seventy patients were classified as having transformed (NP-T); 179 patients had NP-CLL, 12 of whom were diagnosed with RT on repeat biopsy. For patients who received targeted therapy, progression in <1.54 years from treatment initiation to PET was significantly associated with transformation (OR: 4.33; 95% CI: 1.05–17.84; p=0.0422). Other predictors of transformation included number of prior therapies (OR: 1.32 per line; 95% CI: 1.07–1.64; p=0.0094) and maximum standardized uptake value (OR: 2.65 per 5-unit increase; 95% CI: 1.95–3.59; p<0.0001), whereas treatment-naïve status (OR: 0.37, 95% CI: 0.21–0.67; p=0.0010) and trisomy 12 (OR: 0.45, 95% CI: 0.21–0.93; p=0.0400) were identified as protective factors. Patients with NP-T had significantly shorter median OS compared to patients with NP-CLL (1.75 vs. 7.71 years; p<0.0001). Comparing NP-CLL cases to a cohort of treated patients with CLL, OS was significantly decreased in NP-CLL (p<0.0001), with 5- and 10-year OS rates of 86.0% and 54.7% vs 94.9% and 82.7%, respectively.
Access abstract here: https://ashpublications.org/blood/article/146/Supplement%201/5682/555766/Nodal-progression-in-CLL-Real-world-predictors-of