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Research on Immunology
Research on Immunology
iConcept Press

Chapter 1

Research on Immunology

Chemoimmunotherapy or Immunotherapy versus Chemotherapy among Elderly Chronic Lymphocytic Leukemia Patients

by Sacha Satram-Hoang, Carolina Reyes, Sandra Skettino and Khang Q. Hoang

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Introduction: Chronic lymphocytic leukemia (CLL) is a disease of the elderly. The median age at diagnosis is 72, but patients enrolled in randomized trials are often a decade younger making treatment efficacy in elderly patients less understood. We examined real-world treatment patterns and outcomes among elderly CLL patients. Methods: The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database was utilized in this retrospective cohort analysis of 8343 first primary CLL patients. Patients were diagnosed from January 1, 1998 to December 31, 2007, ≥66 years old, and continuously enrolled in Medicare Part A and B with no HMO coverage in the year prior to diagnosis. We conducted a sub-analysis among the treated subset (n=3366) who received first-line therapy with chlorambucil (CLB; n=151), rituximab-monotherapy (R-mono; n=594), rituximab+intravenous chemotherapy (R+IV Chemo; n=696), and IV Chemo-only (n=1544). CLB is covered by Medicare Part D and data for its use were only available from 2007-2009 in the SEER-Medicare dataset. Cox and Logistic regression modeling assessed patient characteristics predictive of receiving treatment within the first year after diagnosis. Kaplan-Meier curves and Cox proportional hazards regression assessed survival by treatment type. Date of last follow-up was December 2009. Results: During the study time period, there were 4977 (60%) patients who did not receive anti-leukemic therapy. Even among high risk patients diagnosed at advanced stage (n=4213), 57% were not treated. Treated patients were younger, more likely male, advanced stage, and had lower comorbidity burden compared to untreated patients. Patients administered CLB and R-mono were the oldest and had the highest comorbidity burden while patients receiving R+IV Chemo were the youngest and had the lowest comorbidity burden (p<0.0001). In multivariate regression analyses, the treatment rate was significantly lower among patients >80 years, females, and with early stage disease; and significantly decreased with increasing comorbidity burden. Receipt of R+IV Chemo was associated with significantly lower mortality risk vs. IV Chemo-only (HR=0.73; 95% CI: 0.62-0.87). A non-significant mortality risk reduction was noted with receipt of R-mono vs. CLB (HR=0.47; 95% CI: 0.21-1.05). Older age and increasing comorbidity score were significantly associated with higher mortality risks. Conclusions: Age, gender, comorbidity and stage were predictive of receiving treatment. These findings suggest that chemoimmunotherapy is more effective than chemotherapy in an elderly population with a high prevalence of comorbidity and this extends the conclusions from clinical trials in younger, medically fit patients.

Author Details

Sacha Satram-Hoang
Department of Epidemiology, Q.D. Research Inc., USA
Carolina Reyes
Department of Health Economics & Outcomes Research, Genentech Inc., USA; Department of Clinical Pharmacy, University of California, San Francisco, USA
Sandra Skettino
U.S. Medical Affairs, Genentech Inc., USA
Khang Q. Hoang
Medical Affairs, Q.D. Research Inc., USA


Sacha Satram-Hoang, Carolina Reyes, Sandra Skettino and Khang Q. Hoang. Chemoimmunotherapy or Immunotherapy versus Chemotherapy among Elderly Chronic Lymphocytic Leukemia Patients. In Research on Immunology. ISBN:978-1-922227-91-1. iConcept Press. 2016.