Reasons for initiation of treatment and predictors of response for patients with Rai stage 0/1 chronic lymphocytic leukemia (CLL) receiving first-line therapy: an analysis of the Connect ® CLL cohort study

Leuk Lymphoma. 2018 Oct;59(10):2327-2335. doi: 10.1080/10428194.2018.1427860. Epub 2018 Feb 7.

Abstract

A 'watch-and-wait' strategy is recommended for most patients with early-stage chronic lymphocytic leukemia (CLL) prior to treatment initiation. In the Connect® CLL registry, a prospective observational cohort study of 1494 patients treated in 199 US centers, median time to first-line treatment initiation was 3.8, 1.5, and 0.6 years for patients with Rai stage 0, 1, and ≥2, respectively. Only 60% of patients with Rai stage 0/1 underwent FISH/cytogenetic testing prior to initiation of a new line of therapy. Lymphocytosis and lymphadenopathy were the most common reasons for treatment initiation. Lymphocytosis as a reason for treatment initiation was associated with inferior event-free survival at Rai stage 0/1. Short treatment duration was associated with inferior overall survival regardless of Rai stage; sensitivity analyses confirmed the association. The Connect CLL registry provides valuable information on a real-world population of patients with CLL, clarifying both the timing and rationale for initiating therapy.

Keywords: Chronic lymphocytic leukemia; Rai staging; registry; treatment initiation.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / standards
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Disease-Free Survival
  • Female
  • Humans
  • Leukemia, Lymphocytic, Chronic, B-Cell / blood
  • Leukemia, Lymphocytic, Chronic, B-Cell / drug therapy*
  • Leukemia, Lymphocytic, Chronic, B-Cell / mortality
  • Leukemia, Lymphocytic, Chronic, B-Cell / pathology
  • Lymphadenopathy / blood
  • Lymphadenopathy / diagnosis
  • Lymphadenopathy / drug therapy*
  • Lymphadenopathy / mortality
  • Lymphocytosis / blood
  • Lymphocytosis / diagnosis
  • Lymphocytosis / drug therapy*
  • Lymphocytosis / mortality
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Prognosis
  • Prospective Studies
  • Registries / statistics & numerical data*
  • Time Factors
  • Time-to-Treatment
  • Young Adult