Abstract
Information on the real-world experience of Canadians diagnosed with chronic lymphocytic leukemia (CLL) is limited. This study was conducted to report treatment patterns and outcomes of CLL using Ontario administrative data. A retrospective cohort study was conducted in patients diagnosed with CLL between 1 January 2010 and 31 December 2017 identified in the Ontario Cancer Registry (OCR). Data were accessed using the Institute of Clinical Evaluative Sciences (ICES), which collects various population-level health information. In the Ontario Cancer Registry, 2887 CLL patients receiving treatment and diagnosed between 2010–2017 were identified. Fludarabine, cyclophosphamide and rituximab (FCR) chemoimmunotherapy was most frequently used as a first line, but use declined since ibrutinib and obinutuzumab combinations were funded in 2015. In patients treated with frontline FCR, survival at year one was 89% pre-2015 and 96% post-2015; at year four, survival was 73% and 87%, respectively. Survival in patients treated with frontline chlorambucil was 76% pre-2015 and 75% post-2015 in year 1, and 45% and 56% in year 3. Our analysis shows that, as the treatment landscape for CLL has shifted, use of newer and novel agents as a first line or earlier in the relapsed/refractory setting has resulted in improved survival outcomes.
Highlights
Chronic lymphocytic leukemia (CLL) is the most common type of adult leukemia in Canada, accounting for about 44% of all leukemias [1]
10,008 patients were diagnosed with CLL from 2010–2017 in Ontario, Canada
Use of FCR steadily decreased over the time period studied, with C + O or ibrutinib being more frequently used in 2017 or 2018, and more frequently used in older patients
Summary
Chronic lymphocytic leukemia (CLL) is the most common type of adult leukemia in Canada, accounting for about 44% of all leukemias [1]. CLL mainly affects older patients, with a median age at diagnosis of 71 years. CLL has a unique disease trajectory, as most patients with CLL are often asymptomatic at presentation, with the majority (>80%) currently being diagnosed at an early stage [4,5]. Many of these patients will have an indolent course for years and usually do not require treatment until the onset of symptoms [4,5]. The optimal first line treatment strategy is largely dependent on the individual patient’s characteristics, including age/fitness level, performance status, and the presence of high-risk cytogenetics, as well as patient preference and social factors, such as caregiver stress and ease of transport [6,7]
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