AGE, COMORBIDITY, AND TIME TO TREATMENT AS DRIVERS OF FIRST-LINE BTKI UTILIZATION IN REAL-WORLD CHRONIC LYMPHOCYTIC LEUKEMIA (CLL): A NORSTELLALINQ ANALYSIS
Author(s)
Isabella Even-Chen, BA1, Shefali Patel, MS2, ilan behm, MPH3, Rahul Das, PhD4, Atharva Manjrekar, MS5, Juan Diego Irizarry-Cole, PhD1, Allison Perry, PhD1.
1Norstella, New York, NY, USA, 2Norstella, Ferndale, MI, USA, 3Norstella, Englewood, CO, USA, 4Norstella, Yardley, PA, USA, 5Norstella, West Hartford, CT, USA.
1Norstella, New York, NY, USA, 2Norstella, Ferndale, MI, USA, 3Norstella, Englewood, CO, USA, 4Norstella, Yardley, PA, USA, 5Norstella, West Hartford, CT, USA.
OBJECTIVES: To characterize how patient age, comorbidity burden, and time from diagnosis to systemic treatment initiation shape first-line regimen selection and treatment duration in CLL.
METHODS: A retrospective cohort study was conducted using NorstellaLinQ’s US real-world linked open claims, structured EHR, and clinical notes (January 2019-September 2025). Among 204,756 incident CLL patients, 24,410 met line-of-therapy eligibility criteria and formed the analytical cohort. Time to treatment was categorized as immediate (<90 days; N=10,905), delayed (91-365 days; N=4,945), or indolent (>1 year; N=8,560). First-line regimen mix was assessed across age groups and cardiometabolic comorbidity combinations. Line-of-therapy assignments used gap-based rules (>90-day gap defined a new line); average line duration was calculated per regimen class.
RESULTS: BTKi monotherapy was the dominant first-line regimen and its share increased progressively with age, becoming the clear majority among patients >=70 years, while chemoimmunotherapy use declined with increasing age. Comorbidity burden produced modest variation in regimen mix; BTKi monotherapy remained prevalent across all comorbidity groups, while patients without comorbidities showed relatively higher BCL-2-based regimen uptake and lower chemoimmunotherapy use. Average BTKi duration at line 1 was 331 days. Treatment population narrowed substantially across lines (24,410 at line 1; 5,356 at line 2; 1,496 at line 3; 479 at line 4), with a large proportion not advancing to subsequent lines.
CONCLUSIONS: BTKi-based therapy remains the predominant treatment approach across lines of therapy in real-world CLL practice. While first-line management is relatively homogeneous, later-line treatment demonstrates increasing regimen diversity and reflects increasing therapeutic complexity, particularly among patients with high-risk molecular features. These findings provide contemporary real-world benchmarks for evaluating emerging therapies in CLL.
METHODS: A retrospective cohort study was conducted using NorstellaLinQ’s US real-world linked open claims, structured EHR, and clinical notes (January 2019-September 2025). Among 204,756 incident CLL patients, 24,410 met line-of-therapy eligibility criteria and formed the analytical cohort. Time to treatment was categorized as immediate (<90 days; N=10,905), delayed (91-365 days; N=4,945), or indolent (>1 year; N=8,560). First-line regimen mix was assessed across age groups and cardiometabolic comorbidity combinations. Line-of-therapy assignments used gap-based rules (>90-day gap defined a new line); average line duration was calculated per regimen class.
RESULTS: BTKi monotherapy was the dominant first-line regimen and its share increased progressively with age, becoming the clear majority among patients >=70 years, while chemoimmunotherapy use declined with increasing age. Comorbidity burden produced modest variation in regimen mix; BTKi monotherapy remained prevalent across all comorbidity groups, while patients without comorbidities showed relatively higher BCL-2-based regimen uptake and lower chemoimmunotherapy use. Average BTKi duration at line 1 was 331 days. Treatment population narrowed substantially across lines (24,410 at line 1; 5,356 at line 2; 1,496 at line 3; 479 at line 4), with a large proportion not advancing to subsequent lines.
CONCLUSIONS: BTKi-based therapy remains the predominant treatment approach across lines of therapy in real-world CLL practice. While first-line management is relatively homogeneous, later-line treatment demonstrates increasing regimen diversity and reflects increasing therapeutic complexity, particularly among patients with high-risk molecular features. These findings provide contemporary real-world benchmarks for evaluating emerging therapies in CLL.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO119
Topic
Clinical Outcomes, Epidemiology & Public Health, Real World Data & Information Systems
Disease
Oncology