CLL-376: Clinical Characteristics and Outcomes of Patients with Chronic Lymphocytic Leukemia (CLL), 80 Years of Age or Older

Abstract

Context: Nearly 20% patients are ≥80 years of age at CLL diagnosis. Increased comorbidities often accompany advanced age. However, clinical trials enroll a disproportionally low number of people this age, providing limited evidence for guidance. Objective: To determine clinical characteristics and outcomes of patients ≥80 years of age at the time of CLL diagnosis. Design: Retrospective. Setting: Academic. Patients or Other Participants: Between 1/1995–3/2020, we identified previously untreated CLL patients from the Mayo Clinic CLL Database ≥80 years of age at the time of CLL diagnosis and seen within 3 years of diagnosis. Main Outcomes Measures: Baseline characteristics, treatments, and time-to-first-treatment (TFT) were analyzed for all patients. Overall survival (OS) was measured from diagnosis date in all patients and separately from treatment date for treated patients. Time-to-next-treatment (TTNT) was measured in treated patients from the first treatment date to the date of second treatment or last known treatment. TFT and TTNT were analyzed accounting for competing risk of death. Cox multivariable regression models were used to determine which factors were associated with OS and TTNT. Results: Among 213 patients identified, the median age was 83 years (range 80–97). The median number of medical comorbidities among all patients was 4 (range 0–8). Fifty-six patients received treatment; median TFT 6.7 years. Treatment approaches included monoclonal antibody alone (n=17), chemotherapy alone (n=17), chemoimmunotherapy (n=14), novel agents (n=3), and multi-agent Richter’s transformation regimens (n=5). Twenty-two of 56 treated patients received second-line therapy (median TTNT 2.8 years). Median OS among all 213 patients was 4.6 years. Standardized mortality ratio was 1.2 (p=0.008), excluding patients with Richter’s transformation. In univariable analyses, receipt of therapy (HR 3.92, 95%CI 2.11–7.28; p Conclusions: Survival was similar across the 25-year span of this study; however, patients treated with novel agents were underrepresented and warrant additional evaluation. The 20% higher risk of death compared to an age- and sex-matched population emphasize the need for ongoing efforts to improve clinical outcomes for CLL patients in this growing demographic.