Real-World Patient Characteristics and Treatment Patterns in Relapsed/Refractory B-Cell Acute Lymphoblastic Leukemia Patients With Long-Term Survivorship
Author(s)
Tammy Schuler, PhD, Puja Aggarwal, PhD, Angele Kotomale, MS, Lindsay McAllister, BA, MPP, Andy Klink, MPH, PhD, Bruce Feinberg, DO;
Cardinal Health, Dublin, OH, USA
Cardinal Health, Dublin, OH, USA
Presentation Documents
OBJECTIVES: This study describes real-world characteristics/treatments among relapsed/refractory acute lymphoblastic leukemia (R/R ALL) patients and long-term survival.
METHODS: Multi-site chart review of R/R B-cell ALL patients diagnosed 9/2017-3/2022, seen primarily in U.S. community oncology clinics. Long-term survivors (“LTS”) lived ≥3 years from initial diagnosis to death/date last seen. LTS/patients who died <3 years post-initial diagnosis were compared.
RESULTS: 24 physicians abstracted charts from N=204: median age 56 years at R/R, 51%/73%/51% male/white/commercially-insured. Prior to R/R, 66% received “hyper CVAD (cyclophosphamide, vincristine sulfate, doxorubicin hydrochloride/adriamycin, dexamethasone, methotrexate, cytarabine) plus (imatinib, ponatinib, dasatinib, rituximab)”, 95%/40%/11%/36% received induction/consolidation/allo-SCT as consolidation/maintenance. 28%/46% had primary refractory disease/early relapse. 30% were LTS, 47% died <3 years post-initial diagnosis, 23% were alive at data collection with < 3-yr survival post-initial diagnosis. Favoring LTS were characteristics: lower age at initial (median: 41 vs. 63 years, P<.001) and R/R (median: 43 vs. 64 years, P<.001) diagnoses, commercially-insured (70% vs. 36%, P<.001), residing in Southern (34% vs. 20%, P=0.026)/Midwest US (25% vs. 15%, P=0.026), longer initial to R/R duration (median: 35 vs. 8 months, P<.001), and lower NCI comorbidity index (median: 0.0, IQR: 0-0.1 vs. median: 0.1, IQR: 0-0.5, P= 0.004), BMI (≥ 25: 46% vs. 69%, P= 0.002), ECOG (0 or 1: 90% vs. 67%, P<.001), KPS (≥80: 57% vs. 30%, P=0.002); disease biology: Philadelphia chromosome positive (31% vs. 23%), not having ≥1 high-risk cytogenetic abnormality (59% vs. 72%); treatments: not receiving “hyper-CVAD plus” (57% vs. 67%, P<.001), receiving consolidation (79% vs. 24%, P<.001), allo-SCT as consolidation (23% vs. 2%, P<.001), maintenance (67% vs. 21%, P<.001), and post-frontline MRD negative (71% vs. 28%, P<.001).
CONCLUSIONS: LTS was prevalent among younger patients achieving MRD who were thus more likely to receive allo-SCT consolidation/maintenance therapy. Limited observations were available for some newer therapeutics, the earlier use of which among poorer-prognostic patients may contribute to LTS.
METHODS: Multi-site chart review of R/R B-cell ALL patients diagnosed 9/2017-3/2022, seen primarily in U.S. community oncology clinics. Long-term survivors (“LTS”) lived ≥3 years from initial diagnosis to death/date last seen. LTS/patients who died <3 years post-initial diagnosis were compared.
RESULTS: 24 physicians abstracted charts from N=204: median age 56 years at R/R, 51%/73%/51% male/white/commercially-insured. Prior to R/R, 66% received “hyper CVAD (cyclophosphamide, vincristine sulfate, doxorubicin hydrochloride/adriamycin, dexamethasone, methotrexate, cytarabine) plus (imatinib, ponatinib, dasatinib, rituximab)”, 95%/40%/11%/36% received induction/consolidation/allo-SCT as consolidation/maintenance. 28%/46% had primary refractory disease/early relapse. 30% were LTS, 47% died <3 years post-initial diagnosis, 23% were alive at data collection with < 3-yr survival post-initial diagnosis. Favoring LTS were characteristics: lower age at initial (median: 41 vs. 63 years, P<.001) and R/R (median: 43 vs. 64 years, P<.001) diagnoses, commercially-insured (70% vs. 36%, P<.001), residing in Southern (34% vs. 20%, P=0.026)/Midwest US (25% vs. 15%, P=0.026), longer initial to R/R duration (median: 35 vs. 8 months, P<.001), and lower NCI comorbidity index (median: 0.0, IQR: 0-0.1 vs. median: 0.1, IQR: 0-0.5, P= 0.004), BMI (≥ 25: 46% vs. 69%, P= 0.002), ECOG (0 or 1: 90% vs. 67%, P<.001), KPS (≥80: 57% vs. 30%, P=0.002); disease biology: Philadelphia chromosome positive (31% vs. 23%), not having ≥1 high-risk cytogenetic abnormality (59% vs. 72%); treatments: not receiving “hyper-CVAD plus” (57% vs. 67%, P<.001), receiving consolidation (79% vs. 24%, P<.001), allo-SCT as consolidation (23% vs. 2%, P<.001), maintenance (67% vs. 21%, P<.001), and post-frontline MRD negative (71% vs. 28%, P<.001).
CONCLUSIONS: LTS was prevalent among younger patients achieving MRD who were thus more likely to receive allo-SCT consolidation/maintenance therapy. Limited observations were available for some newer therapeutics, the earlier use of which among poorer-prognostic patients may contribute to LTS.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO40
Topic
Clinical Outcomes
Topic Subcategory
Clinician Reported Outcomes
Disease
SDC: Oncology