Background: Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults, including elderly veterans, with many new treatment options now available. Data on patterns of treatment in elderly veteran patients with CLL is limited. We sought to assess initial treatment patterns over a 13-year period among veteran patients in the Minneapolis VA Health Care System.
Methods: We identified 6,756 CLL cases diagnosed from 2000 to 2013 and are presenting interim data on 2015. We reviewed clinical data from 2,015 patients with CLL diagnosed from 2000 to 2013 and identified through the National VA Tumor Registry. Baseline demographics and treatment information were collected. The objective of this study was to assess initial treatment patterns, time to initial treatment, and variation of these parameters by age.
Results: At diagnosis, median age was 69 years (range, 37-96 years); 98% were male (1,979); Rai stage was 0 (n = 1,331, 66%), 1 (n = 317, 16%), 2 (n = 156, 8%), 3 (n = 91, 5%), 4 (n = 113, 6%). The majority of patients were white (n = 1,752, 87%); followed by African American (n = 203, 10%); and Hispanic (n = 33, 2%). Of the 2,015 patients, 751 (37%) received therapy over this period of follow-up. Median time from diagnosis to initial treatment was 1.3 years (range, 0-13 years). The most common initial therapies utilized were chlorambucil (39.4%); fludarabine/cyclophosphamide/ritux-imab (FCR) (12.4%); and single-agent fludarabine (10.5%). When examining these parameters by age in decades, we found that there were no differences in Rai stage at diagnosis by age-decade. There was a progressive increase in initial chlorambucil usage by advancing age. Likewise, the majority of FCR usage was in patients aged < 70 years.
Conclusions: In this veteran population, including many elderly patients, the majority of patients requiring therapy initiated it within 2 years of diagnosis. These patients were most commonly treated with chlorambucil. These patterns of care will be changing with the introduction of newer oral agents, such as ibrutinib and idelalisib, but at a significantly higher cost. The National VA Tumor Registry data will allow future opportunity to examine evolving treatment patterns in both an elderly as well as a veteran population. Updated data will be presented at the AVAHO annual meeting.