REAL-WORLD TREATMENT PATTERNS IN CHRONIC LYMPHOCYTIC LEUKEMIA: A SYSTEMATIC REVIEW
Author(s)
Magdalena Monica, PhD1, Monika Reczek, MSc2, Pawel Kawalec, PhD, MD3.
1Health Economics and Market Access, Thermo Fisher Scientific, Warsaw, Poland, 2HTA Consulting, Kraków, Poland, 3Institute of Public Health, Jagiellonian University, Kraków, Poland.
1Health Economics and Market Access, Thermo Fisher Scientific, Warsaw, Poland, 2HTA Consulting, Kraków, Poland, 3Institute of Public Health, Jagiellonian University, Kraków, Poland.
OBJECTIVES: Since the introduction of targeted therapies, the treatment landscape of chronic lymphocytic leukemia (CLL) has shifted from chemotherapy (CT) and chemoimmunotherapy (CIT) toward Bruton tyrosine kinase inhibitors (BTKis) and B-cell lymphoma 2 inhibitors (BCL2is). This systematic review aimed to characterize real-world treatment patterns, sequencing, and utilization outcomes in patients with CLL in the targeted therapy era.
METHODS: A systematic literature search was conducted in PubMed/MEDLINE, Embase, and ClinicalTrials.gov on January 28, 2026. Real-world studies of adult patients with CLL initiating treatment from 2016 onward were eligible. Data on treatment distributions, sequencing, and utilization were synthesized descriptively. Exploratory meta-analyses were conducted for treatment distributions reported in ≥5 studies.
RESULTS: Overall, 25 publications corresponding to 23 studies and 13,450 patients were included. Real-world treatment patterns showed a substantial uptake of targeted therapy, although their use varied across geographic regions. In 1L, targeted therapy use ranged from 1.0-73.9% across studies and was numerically higher in Europe and the US than in ROW cohorts, whereas CIT/CT remained frequent, accounting for 25.1-90.4%. Non-standard or non-approved 1L regimens were also reported in individual studies. In exploratory meta-analysis, the pooled proportion of 1L targeted therapy was 0.33 (95% CI: 0.26-0.42), compared with 0.53 (95% CI: 0.41-0.65) for CIT/CT. In 2L, targeted therapy was more prominent, with a pooled proportion of 0.59 (95% CI: 0.40-0.76), and BTKi regimens were the dominant targeted class. Sequencing data were fragmented but included 901 reported 1L→2L transitions, most commonly after prior BTKi, followed by another BTKi regimen (n = 543) or BCL2i (n = 220). Discontinuation ranged from 16.8-61.1% across treatment lines, and TTNT estimates ranged from 4.6-45.7 months.
CONCLUSIONS: Real-world CLL treatment has shifted toward targeted therapy, particularly in later lines, but uptake remains heterogeneous, with higher use in Europe and the US than in ROW cohorts.
METHODS: A systematic literature search was conducted in PubMed/MEDLINE, Embase, and ClinicalTrials.gov on January 28, 2026. Real-world studies of adult patients with CLL initiating treatment from 2016 onward were eligible. Data on treatment distributions, sequencing, and utilization were synthesized descriptively. Exploratory meta-analyses were conducted for treatment distributions reported in ≥5 studies.
RESULTS: Overall, 25 publications corresponding to 23 studies and 13,450 patients were included. Real-world treatment patterns showed a substantial uptake of targeted therapy, although their use varied across geographic regions. In 1L, targeted therapy use ranged from 1.0-73.9% across studies and was numerically higher in Europe and the US than in ROW cohorts, whereas CIT/CT remained frequent, accounting for 25.1-90.4%. Non-standard or non-approved 1L regimens were also reported in individual studies. In exploratory meta-analysis, the pooled proportion of 1L targeted therapy was 0.33 (95% CI: 0.26-0.42), compared with 0.53 (95% CI: 0.41-0.65) for CIT/CT. In 2L, targeted therapy was more prominent, with a pooled proportion of 0.59 (95% CI: 0.40-0.76), and BTKi regimens were the dominant targeted class. Sequencing data were fragmented but included 901 reported 1L→2L transitions, most commonly after prior BTKi, followed by another BTKi regimen (n = 543) or BCL2i (n = 220). Discontinuation ranged from 16.8-61.1% across treatment lines, and TTNT estimates ranged from 4.6-45.7 months.
CONCLUSIONS: Real-world CLL treatment has shifted toward targeted therapy, particularly in later lines, but uptake remains heterogeneous, with higher use in Europe and the US than in ROW cohorts.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD87
Topic
Health Service Delivery & Process of Care, Real World Data & Information Systems
Disease
Oncology