Access to care and survival outcomes in older adults with chronic lymphocytic leukemia/small lymphocytic lymphoma: a National Cancer Database study. In this retrospective cohort study, researchers compared access to care and survival outcomes among elderly patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) treated at academic cancer programs (ACPs) vs community cancer programs (CCPs). Patients aged ≥75 years diagnosed with CLL/SLL between 2004 and 2022 were eligible for inclusion. A total of 32,752 patients treated at ACPs and 36,576 patients treated at CCPs were included for analysis. A higher proportion of patients at ACPs vs CCPs were Black (7% vs 5%) or Hispanic (3% vs 2%) and had Medicaid, private insurance, or no insurance, whereas more patients treated at CCPs had Medicaid and were from lower-income and lower-education regions (all P<0.001). The proportion of patients with a Charlson–Deyo comorbidity score ≥2 was 13% at CCPs vs 12% at ACPs (P<0.001). Active surveillance was a more common management strategy at ACPs compared to CCPs (34% vs 30%). Treatment initiation rates and median time to systemic therapy were similar between groups, as were 30- and 90-day mortality rates. Median overall survival (OS) was slightly longer at ACPs (4.7 months) compared to CCPs (4.5 months). ACPs showed numerically higher 2-, 5-, and 10-year OS rates of 72%, 48%, and 20%, respectively, compared to 71%, 46%, and 19%, respectively, for CCPs.
Access abstract here: https://www.asco.org/abstracts-presentations/261902
Comparative outcomes in chronic lymphocytic leukemia patients with and without myasthenia gravis: a propensity score–matched analysis. Here, researchers conducted a propensity score–matched study to evaluate outcomes among patients with CLL with and without comorbid myasthenia gravis (MG). Each group consisted of 171 patients. Patients with CLL and MG had a numerically higher mortality risk compared to those with CLL alone, but this difference was not significant (18.1% vs 16.4%; risk difference: −0.018; 95% confidence interval [CI]: −0.098 to 0.063; P=0.668). The proportion of patients with CLL alone who were hospitalized was 29.2% compared to 39.2% for those with CLL and MG, resulting in a risk difference of −0.099 (95% CI: −0.199 to 0.001; P=0.053). The percentage of patients who developed sepsis/bacteremia did not significantly differ between the CLL only and CLL and MG groups (17.0% vs 20.5%; risk difference: −0.035; 95% CI: −0.118 to 0.048; P=0.405). The CLL and MG group showed a significantly higher rate of acetylcholinesterase inhibitor use vs the CLL alone group (46.2% vs. 5.8%; risk difference: −0.404; 95% CI: −0.486 to −0.321; P<0.001); additionally, significantly more patients with CLL and MG used corticosteroids (74.9% vs. 56.1%; risk difference: −0.187; 95% CI: −0.286 to −0.088; P<0.001) and steroid-sparing agents (15.2% vs. 5.8%; risk difference: −0.094; 95% CI: −0.158 to −0.029; P=0.005). OS did not significantly differ based on MG status (log-rank P=0.738); however, survival decreased for patients with CLL and MG in certain therapeutic subgroups.
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Risk factors for second primary malignancies (SPM) in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL): a real-world study. Patients with CLL/SLL are at increased risk of developing a second primary malignancy (SPM). In this study, researchers aimed to identify risk factors associated with SPM in this patient population. Data from the Symphony open claims database on adult patients diagnosed with CLL/SLL from January 1, 2019, to May 31, 2023, were utilized for analysis; patients were divided into groups based on treatment modality. Among 86,654 patients, 11,352 received first-line treatment with a covalent Bruton tyrosine kinase (cBTK) inhibitor, 12,589 received first-line chemoimmunotherapy, and 62,713 were managed with active observation. The incidence of SPM (excluding nonmelanoma skin cancer and hematologic malignancies) over 36-month follow-up significantly differed between groups, at 16.6% in the chemoimmunotherapy group, 13.1% in the cBTK inhibitor group, and 11.8% in the active observation group (P<0.0001). In the overall cohort, factors independently associated with heightened SPM risk included age ≥70 years (odds ratio [OR]: 1.43; 95% CI: 1.36–1.50), male sex (OR: 1.32; 95% CI: 1.26–1.38), liver disease (OR: 1.30; 95% CI: 1.19–1.41), chronic pulmonary disease (OR: 1.26; 95% CI: 1.19–1.34), and 3-factor risk estimate scale score of 2 to 3 (vs 0–1; OR: 1.11; 95% CI: 1.05-1.18). Similar findings were observed in treatment subgroups. Age ≥70 years remained a notable prognostic factor in the cBTK inhibitor (OR: 1.35; 95% CI: 1.19–1.54), chemoimmunotherapy (OR: 1.22; 95% CI: 1.09–1.36), and active observation groups (OR: 1.52; 95% CI: 1.43–1.61), as did male sex (cBTK inhibitor, OR: 1.33; 95% CI: 1.17–1.51; chemoimmunotherapy, OR: 1.19; 95% CI: 1.07–1.33; active observation, OR: 1.34; 95% CI: 1.34; 95% CI:1.27–1.42).
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Clinical and socioeconomic prognostic factors in chronic lymphocytic leukemia with normal FISH. While about 20% of patients with CLL have normal fluorescence in situ hybridization (FISH) results, data regarding prognostic factors remains limited. In this single-center retrospective study, researchers aimed to determine prognostic factors in adult patients with CLL and normal FISH results. In total, 163 patients with CLL and normal FISH results between 2007 and 2025 were included for analysis. Median age was 66.2 years. Most patients were non-Hispanic White (89%) and had Medicare (66.2%), and 50.3% were male. IGHV mutations were present in 66.2% of patients. At median 65-month follow-up, median time to treatment initiation was 32 months. The 5-year OS rate was 92.1%. Factors associated with decreased survival on multivariable analysis included Medicaid (hazard ratio [HR]: 5.58; 95% CI: 1.90–16.39; P<0.002), other/uninsured (HR: 3.86; 95% CI: 2.11–7.05; P<0.001), commercial insurance (HR: 3.23; 95% CI: 1.91–5.50; P<0.001), and older age (HR: 1.06; 95% CI: 1.03–1.08; P<0.001); these factors were also associated with shorter time to treatment initiations, with HRs (95% CIs) of 4.36 (1.52–12.52; P=0.0063), 2.11 (1.17–3.82; P=0.0137), 2.2 (1.32–3.68; P=0.0025), and 1.04 (1.02–1.06, P<0.0001), respectively. IGHV mutation status showed no association with survival (HR: 1.08; 95% CI: 0.76–1.52; P=0.67) or time to treatment initiation (HR: 0.93; 95% CI: 0.66–1.31; P=0.67).
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Impact of substance use disorder on pneumonia hospital outcomes in chronic lymphocytic leukemia: an inpatient nationwide analysis. Researchers analyzed data from the National Inpatient Sample analysis spanning 2016 to 2023 to evaluate the impact of substance use disorder (SUD) on pneumonia outcomes in hospitalized patients with CLL. In total, 127,915 patients with CLL and pneumonia were included for analysis; 1,990 patients (1.56%) had documented SUD. A significantly greater percentage of patients with SUD vs those without SUD were 50 to 69 years of age (54.77% vs 24.71%), had a median household income <$57,488 (37.44% vs 25.44%), and had Medicaid insurance (22.36% vs 3.39%; all P<0.001). A total of 55.3% of patients with SUD were smokers compared to 39.17% of patients without SUD (P<0.001). Chronic pulmonary disease (52.26% vs 39.81%) and depression (22.11% vs 12.03%) were more prevalent in the SUD group vs no SUD group (both P<0.001). Hypertension was significantly more prevalent in patients without SUD (70.04% vs 63.88%), as were diabetes (30.54% vs 23.87%) and dementia (9.01% vs 3.27%; all P<0.001). Following propensity score matching (PSM), the rate of discharge against medical advice was 7.29% in the SUD group compared to 1.26% in the no SUD group (P<0.001). The rate of in-hospital mortality was 7.29% among patients with SUD and 9.20% among patients without SUD; this difference was not significant after multivariate adjustment (adjusted OR [aOR]: 1.05; 95% CI: 0.70–1.58; P=0.816) and after PSM (aOR: 0.84; 95% CI: 0.50–1.40; P=0.497). Invasive mechanical ventilation occurred in 15.83% of patients with SUD vs 8.94% of patients without SUD (aOR: 1.42; 95% CI: 1.05–1.93; P=0.024). Patients with SUD also had a significantly higher likelihood of pneumothorax (2.26% vs 0.73%; aOR: 2.70; 95% CI: 1.35–5.41; P=0.005) and vasopressor use (5.03% vs 2.59%; aOR: 1.80; 95% CI: 1.06–3.05; P=0.029).
Access abstract here: https://www.asco.org/abstracts-presentations/261895