OBJECTIVES

: To estimate HRU associated with treatment in adults with Ph+ R/R BCP ALL in France, Italy, Spain, and UK.

METHODS

: A Delphi-based methodology was employed to generate estimates of HRU of common treatments for Ph+ R/R BCP ALL patients relapsed/refractory to at least one second-generation tyrosine kinase inhibitor (TKI). The study had two phases: a questionnaire administered to physicians with ≥5-years’ R/R ALL experience; and a country-specific panel to discuss these results. The duration of treatment and inpatient length-of-stay (LOS) for the most widely-used treatment regimen was presented.

RESULTS

: In France, 67% of patients with Ph+ R/R BCP ALL were treated with a TKI+chemotherapy (e.g. vincristine+steroids) for induction and consolidation of 6/8 cycles followed by TKI monotherapy maintenance for 18 months. Mean LOS was the same for one cycle of induction and consolidation (21 days). In Italy, 86% patients were treated with TKI monotherapy for either 3 months (followed by hematopoietic stem-cell-transplant [HSCT] [33%]) or 7 months (no HSCT [67%]). Inpatient stays only occurred during the first month (9.8 days). In Spain, the most commonly used regimens were TKI monotherapy (90% received ponatinib for 7 months; 10% received dasatinib for 4 months) and TKI+chemotherapy (1 cycle each of induction and consolidation). The mean LOS/month was 8 days for both TKI monotherapies. For TKI+chemotherapy, more inpatient stays were needed for one cycle of induction (17 days) than consolidation (11 days). In the UK, 50% patients were treated with FLAG-IDA-based chemotherapy (1 cycle each of induction and consolidation) followed by ponatinib for a mean of 7.9 months. Mean inpatient stays for one cycle of induction and consolidation were 31 days and 23 days, respectively.

CONCLUSIONS

: In EU-4 countries, adult Ph+ R/R BCP ALL patients experience substantial inpatient stays during treatment with conventional therapies, causing substantial economic burden. Novel therapies that reduce HRU are needed.