BACKGROUND: CLL (Chronic Lymphocytic Leukaemia) is the most common form of leukaemia in Western countries. Although recent therapeutic options have notably improved the clinical outcomes, for patients with contraindications against the use of B-cell receptor inhibitors (BCRi) CLL remains an incurable disease. Epidemiological data show a substantially lower 5-year survival rate for people with CLL in Eastern Europe (including Poland) compared to the Northern European countries (54% vs. 78%). This review will focus on targeted agents, such as ibrutinib, idelalisib and venetoclax, currently approved by EMA, and immunotherapies: rituximab, obinutuzumab, ofatumumab.

OBJECTIVES: Literature review to identify barriers to effective treatment of patients with CLL in Poland vs the United Kingdom.

METHODS: Non-systematic search of PubMed, Web of Science and Embase databases was performed to identify relevant publications. Additionally, clinical practice recommendations, reimbursement lists of drugs in Poland and the UK, list of registered therapies in Europe were searched on 15^th June 2017.

RESULTS: At present, the biggest barrier for Polish patients with CLL and physicians is the limited range of reimbursed therapies, not covering the most innovative therapies. There were 3342 patients received at least one line of treatment for CLL in 2015 in Poland and only two innovative drugs, rituximab and obinutuzumab, are reimbursed in the CLL indication. In contrast, all new drugs are licensed in the UK: ibrutinib, idelalisib, rituximab, obinutuzumab, ofatumumab are recommended by NICE and venetoclax is under appraisal. In Poland, there is a narrow group of patients requiring special treatment due to contraindications against the use of BCRi (about 25- 26% of patients).

CONCLUSIONS: Poland is lagging behind the Western countries in terms of availability of recent effective treatments for patients with CLL. Despite the implementation of more effective therapeutic options in Europe, the patients’ needs have not been fully met in Poland.