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ASCO 2020 Top 12” #12: The shift in therapies for the treatment of CLL patients in the US Veterans Health Administration (VHA) from 2013-2018

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In short videos with accompanying text, Dr. Brian Koffman, the Executive Vice President (EVP) and Chief Medical Officer (CMO) of the CLL Society, takes us through his “Top 12” abstracts from ASCO or the American Society of Clinical Oncology Annual Meeting held virtually in May, 2020.

#12

The shift in therapies for the treatment of chronic lymphocytic leukemia (CLL) patients in the US Veterans Health Administration (VHA) from 2013-2018.

This is a straight-ahead good news abstract that says finally our veterans are getting better care for their chronic lymphocytic leukemia, though there is still more work to be done.

Takeaways:

  • This was a retrospective study of 26,879 adults with CLL receiving benefits from the VHA from 10/01/2013 to 5/31/2018.
  • Data were extracted from VHA electronic health records.
  • Surprisingly, only 6% had a history of exposure to Agent Orange. Such exposure is known to increase CLL risk, and veterans with CLL who have been exposed are eligible for significant benefits.
  • Ibrutinib accounted for 89% of all the novel agents and was used across all lines of treatment from frontline to relapsed/refractory CLL.
  • In 2014, 228 patients were treated with ibrutinib. By 2018, the number was 1,603.
  • Traditional chemotherapy (CT) and chemo-immunotherapy (CIT) consistently declined steadily in use over the study period.
  • However, in 2018, 17% of patients were still receiving CT/CIT. There is no role for CT in treating CLL and little role for CIT.
  • Incidence of diffuse large B cell lymphoma (DLBCL) or Richter’s Syndrome was 2–6 times higher in patients on CT/CIT than in those on ibrutinib.
  • Other secondary complications were similar between ibrutinib and CT/CIT.

Conclusions:

This is real and well measured progress.

Veterans are increasingly receiving CLL medications in step with the latest research and guidelines. It is worth noting that 17% of vets are still getting some form of chemo and that chemo significantly increased the risk of their CLL transforming into the aggressive lymphoma known as Richter’s Syndrome.

But the overall the trend is positive.

Here is the link to The shift in therapies for the treatment of chronic lymphocytic leukemia (CLL) patients in the US Veterans Health Administration (VHA) from 2013-2018.

Stay strong.  We are all in this together.

Brian

Brian Koffman MDCM (retired) MS Ed
Co-Founder, Executive VP and Chief Medical Officer
CLL Society, Inc.