REAL-WORLD CLINICAL INDICATORS PRIOR TO FIRST-LINE TREATMENT INITIATION IN CHRONIC LYMPHOCYTIC LEUKEMIA (CLL): A NORSTELLALINQ CLAIMS AND EHR ANALYSIS
Author(s)
Isabella Even-Chen, BA1, ilan behm, MPH2, Shefali Patel, MS3, Rahul Das, PhD4, Atharva Manjrekar, MS5, Juan Diego Irizarry-Cole, PhD1, Allison Perry, PhD1.
1Norstella, New York, NY, USA, 2Norstella, Englewood, CO, USA, 3Norstella, Ferndale, MI, USA, 4Norstella, Yardley, PA, USA, 5Norstella, West Hartford, CT, USA.
1Norstella, New York, NY, USA, 2Norstella, Englewood, CO, USA, 3Norstella, Ferndale, MI, USA, 4Norstella, Yardley, PA, USA, 5Norstella, West Hartford, CT, USA.
OBJECTIVES: To characterize the clinical profile and pre-treatment journey of patients with chronic lymphocytic leukemia (CLL) prior to first-line treatment initiation using linked claims, structured EHR, and clinical notes.
METHODS: A retrospective cohort study was conducted using NorstellaLinQ’s US real-world linked open claims, structured EHR, and clinical notes. Patients with incident CLL were identified via ICD-10-CM codes C83.0 and C91.1, requiring >=2 diagnoses >=30 days apart on or after January 1, 2019, with no prior CLL diagnosis in the full available data history (EHR from 2015; open claims from 2017), ensuring a minimum two-year lookback to confirm incidence. Patients initiating systemic treatment were included; index date was first-line treatment initiation. Demographics, comorbidities, stage (Rai/Binet), biomarker status, time to treatment, and first-line regimen patterns were descriptively assessed.
RESULTS: Among 204,756 incident CLL patients, 24,410 initiated systemic treatment; 79% were >=61 years at diagnosis (largest share: 71-80 age group, 34%).. Timing to systemic treatment initiation varied: 45% within 90 days, 20% between 91 and 365 days, and 35% after one year or more, of initial diagnosis. 30% had at least one cardiovascular or renal comorbidity prior to therapy. BTKi monotherapy was the most common first-line systemic regimen, with utilization higher among older patients and those with greater comorbidity burden. Rai/Binet stage and biomarker status were unavailable in claims or structured EHR; human-in-the-loop large language model (LLM) extracted clinical notes identified staging for 6,523 patients and biomarker status for 3,612.
CONCLUSIONS: Patients with CLL frequently experience prolonged periods between diagnosis and treatment initiation and present with substantial comorbidity burden. Rai/Binet stage and biomarker status are not routinely available in structured data but can be recovered from clinical notes, highlighting the value of multimodal real-world data for characterizing treatment-eligible CLL populations.
METHODS: A retrospective cohort study was conducted using NorstellaLinQ’s US real-world linked open claims, structured EHR, and clinical notes. Patients with incident CLL were identified via ICD-10-CM codes C83.0 and C91.1, requiring >=2 diagnoses >=30 days apart on or after January 1, 2019, with no prior CLL diagnosis in the full available data history (EHR from 2015; open claims from 2017), ensuring a minimum two-year lookback to confirm incidence. Patients initiating systemic treatment were included; index date was first-line treatment initiation. Demographics, comorbidities, stage (Rai/Binet), biomarker status, time to treatment, and first-line regimen patterns were descriptively assessed.
RESULTS: Among 204,756 incident CLL patients, 24,410 initiated systemic treatment; 79% were >=61 years at diagnosis (largest share: 71-80 age group, 34%).. Timing to systemic treatment initiation varied: 45% within 90 days, 20% between 91 and 365 days, and 35% after one year or more, of initial diagnosis. 30% had at least one cardiovascular or renal comorbidity prior to therapy. BTKi monotherapy was the most common first-line systemic regimen, with utilization higher among older patients and those with greater comorbidity burden. Rai/Binet stage and biomarker status were unavailable in claims or structured EHR; human-in-the-loop large language model (LLM) extracted clinical notes identified staging for 6,523 patients and biomarker status for 3,612.
CONCLUSIONS: Patients with CLL frequently experience prolonged periods between diagnosis and treatment initiation and present with substantial comorbidity burden. Rai/Binet stage and biomarker status are not routinely available in structured data but can be recovered from clinical notes, highlighting the value of multimodal real-world data for characterizing treatment-eligible CLL populations.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD169
Topic
Clinical Outcomes, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Oncology