Clinical and demographic characteristics of CLL patients receiving first-line bendamustine plus rituximab using the Flatiron Health database.

Abstract

e19010 Background: Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in the Western world, with 20,110 new cases estimated for 2017 in the US alone. Combination therapy with bendamustine plus rituximab (BR) is among the approved first-line therapies for CLL patients without the 17p deletion. The purpose of this analysis was to characterize CLL patients receiving first-line BR therapy using real-world data. Methods: CLL patients (ICD-9: 204.1x or ICD-10: C91.1x, C83.0x) receiving first-line BR therapy between 11/01/2008 and 11/01/2016 were identified in the Flatiron Health electronic health records database. This database is a large, longitudinal, demographically and geographically diverse database consisting of 250 cancer clinics representing more than 1.5 million active US cancer patients. Results: Of the 2736 CLL patients in the database, 738 patients (male = 70%; mean age = 68.71 years, SD = 9.070) received first-line BR therapy. The majority of patients received treatment in a community setting (93%; 7% in academic hospitals). Prior to first-line BR therapy, immunoglobulin heavy chain variable region ( IGHV) mutation analysis was conducted in 21% of patients, of which 46% were IGHV mutated. Fluorescence in situhybridization (FISH) testing was conducted in 60% of patients: 17p deletion was detected in 8% and 11q deletion in 19%. Trisomy 12 and 13q deletion as a single abnormality was identified in 17% and 27% of tested patients, respectively. Conclusions: CLL patients from the Flatiron database initiating first-line BR therapy have an older median age, male predominance, and community-based treatment setting, which offers a more real-world patient population in comparison with patients reported from clinical trials. Less than a quarter of these CLL patients were tested for IGHV mutations, and only 60% were tested for FISH. The low frequency of testing prior to first-line therapy is similar to other published registry data. This representative patient population offers an insight into the real-world use of BR in CLL patients.