Abstract 4608

Background:

FCR has been a preferred 1st line therapy approach in CLL for the past decade. However it is associated with substantial toxicity and not recommended in NCCN guidelines for patients over age 70. We studied the impact of age, co-morbidities, and tempo of disease on 1st line therapy prescribing preferences of American hematology-oncology physicians (AHOP) for patients with CLL.

Methods:

During Feb-March 2012, prescribing preferences of 325 individual AHOP were assessed using a proprietary, live, case-based market research tool (Challenging Cases™). A core case scenario was constructed with variations based on altered age, co-morbidities, and tempo of disease progression prior to initial therapy. Preference data were acquired using blinded audience response technology. Responses for each scenario were obtained prior to any display of participant selections. All sources of research support were blinded. Core scenario: 67y male; CD 38+, ZAP 70+, del 13q and del 11q CLL, adenopathy, lymphocytosis, splenomegaly, anemia (Hgb 9.5 gm) but no thrombocytopenia. Co-morbidities: medication-controlled hypertension, moderate restrictive airways disease, and type 2 diabetes managed with metformin. Modified scenario: same clinical presentation except the patient is 72 years of age. Slower tempo of disease scenario: age 68y, time frame of observation without treatment 3 years from diagnosis, now with disease progression, anemia 10.9 gms, FISH only del 13q.

Results:

A progressive decrease in preference for FCR and commensurate rise in preference for BR as first line therapy occurs as age increases and co-morbidities are present (p<0.001). See table 1 

Conclusion:

As age crosses the 70 year threshold and as co-morbidities complicate therapy, there is a statistically significant increase in preference among AHOPs for prescribing bendamustine-rituximab as initial management for patients with RAI stage III CLL.

Table.

Choice of 1st line therapy in CLL

First-line therapyAge 67; del11q &13q No comorbidities N = 325Age 67 del11q/13q Co-morbidities N = 322Age 72 del11q/13q No comorbidities N = 324Age 72 del11q/13q Co-morbidities N = 324Age 68; del13q 3 year tempo N = 325
Fludarabine-based 54% 42% 35% 12% 30% 
    FCR 46% 33% 16% 5% 22% 
    Flu ± R/FCR-lite 8%/n/o** 9%/n/o 9%/10% 4%/3% 8%/n/o 
Bendamustine-based 28% 44% 48% 69% 40% 
    Bendamustine-R 27% 42% 46% 66% 35% 
    Bendamustine 1% 2% 2% 3% 2% 
Other* 10% 7% 9% 12% 3% 
No treatment now 8% 7% 8% 7% 30% 
First-line therapyAge 67; del11q &13q No comorbidities N = 325Age 67 del11q/13q Co-morbidities N = 322Age 72 del11q/13q No comorbidities N = 324Age 72 del11q/13q Co-morbidities N = 324Age 68; del13q 3 year tempo N = 325
Fludarabine-based 54% 42% 35% 12% 30% 
    FCR 46% 33% 16% 5% 22% 
    Flu ± R/FCR-lite 8%/n/o** 9%/n/o 9%/10% 4%/3% 8%/n/o 
Bendamustine-based 28% 44% 48% 69% 40% 
    Bendamustine-R 27% 42% 46% 66% 35% 
    Bendamustine 1% 2% 2% 3% 2% 
Other* 10% 7% 9% 12% 3% 
No treatment now 8% 7% 8% 7% 30% 
*

Alemtuzumab + R; Rituximab alone; Pentostatin-cyclophosphamide-R; lenalidomide + R

**

n/o = not offered as an option

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Disclosures:

Green:Xcenda: Employment; Teva: Consultancy, ownes publically traded shares in Teva Pharmaceuticals through 3rd party investment advisors, ownes publically traded shares in Teva Pharmaceuticals through 3rd party investment advisors Other. Williams:Xcenda: Honoraria. Willey:Xcenda: Employment. Scharf:Xcenda: Employment. Neely:xcenda: Employment. Foran:Xcenda: Honoraria.

Topics:
airway device, alemtuzumab, anemia, bendamustine, cyclophosphamide, diabetes mellitus, type 2, did not receive therapy or drug, disease progression, fludarabine, hemoglobin

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2012 by The American Society of Hematology
2012
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