Ureteral Metastasis From Prostate Cancer: A Report of Two Cases
Chemotherapy Regimens Remain Most Common First-Line Treatment For CLL
The use of targeted therapies for chronic lymphocytic leukemia (CLL) has increased over time, but chemotherapy regimens remain the most common first-line treatment for CLL, according to research published in HemaSphere.
The researchers noted that BTK and BCL2 inhibitors, alone or as part of combination regimens, have proven superior to chemoimmunotherapy in the first-line and relapsed/refractory settings, but the targeted agents are rarely used as first-line therapy. They are becoming more common in the second line and later, however.
The researchers conducted this study to evaluate real-world treatment patterns for patients with CLL in 25 countries. The study included 7382 patients — 7134 with CLL and 248 with small lymphocytic lymphoma. The patients had received first-line treatment between 2000 and 2016. The median patient age was 64 years at diagnosis and 66 years at the time of first treatment.
The median follow-up was 7.33 years from diagnosis and 5.27 years from first treatment. Most patients (93.2%) received at least 1 line of chemotherapy or chemoimmunotherapy, and 2.7% received novel agents only.
The most common first-line treatment was fludarabine, cyclophosphamide, and rituximab (FCR), which was given to 35.3% of patients. Other common first-line treatments were chlorambucil alone (17.5%), other chemotherapy (12.2%), bendamustine plus rituximab (9.6%), other chemoimmunotherapy (8.2%), and chlorambucil plus rituximab (5.8%).
Two percent of patients received first-line treatment with BTK inhibitors, with or without anti-CD20 monoclonal antibodies (mAbs). These patients had participated in clinical trials and/or had TP53 mutations. Less than 1% of patients (0.3%) had received first-line venetoclax, all as part of a clinical trial.
In patients with relapsed/refractory CLL (n=8145), BTK inhibitors with or without anti-CD20 mAbs were the most common treatment, given to 19.4% of patients.
The most common second-line treatments were bendamustine plus rituximab (17%), BTK inhibitors with or without anti-CD20 mAbs (15.7%), FCR (15.2%), and other chemoimmunotherapy (12.8%).
BTK inhibitors with or without anti-CD20 mAbs were the most common third-line treatment (22.5%) and later-line treatment (22.4%).
The researchers noted that, due to the approval of novel agents for relapsed/refractory CLL, the use of chemotherapy and chemoimmunotherapy generally decreased after 2014, although bendamustine plus rituximab was the exception.
"We chart a major shift in treatment patterns before and after the introduction of novel targeted agents in 2014," the researchers wrote. "Against that, many patients with R/R [relapsed/refractory] CLL in our cohort were still treated with CIT [chemoimmunotherapy] even after 2014."
The researchers speculated that this might be explained by "the fact that CIT was considered a valid retreatment option for patients with long first remissions for quite some time after 2014" as well as a lack of access to novel agents, physician reluctance to use novel agents, and the evidence-practice gap.
"This highlights the need for more timely and effective knowledge dissemination, but even more importantly, reduction of drug costs and adoption of less strict rules for drug reimbursement," the researchers concluded.
Disclosures: This research was supported by AbbVie, AIRC, the Italian Ministry of Health, the Ministry of Health of the Czech Republic, and the National Institute for Cancer Research of the European Union. Some study authors disclosed conflicts of interest. Please see the original reference for complete disclosures.
What To Know About Chronic Lymphocytic Leukemia (CLL) Flow Cytometry
Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Chronic Lymphocytic Leukemia (CLL) Vs. Multiple Myeloma
CLL and multiple myeloma are two types of blood cancer that have some similarities and differences. Both conditions may not cause symptoms at first but can include fatigue, swollen lymph nodes, and unexplained weight loss.
Blood cancer is an umbrella term for cancers that affect your blood cells and bone marrow. Experts have discovered more than 100 types of blood cancer, which fall into three primary categories:
Each category of blood cancer can fall into subcategories depending on how the cancer develops and the type of cells affected.
Chronic lymphocytic leukemia (CLL) is the most common form of leukemia in adults. Multiple myeloma is the most common form of plasma cell tumor. If the CLL process occurs in the lymph nodes, it's called small lymphocytic lymphoma (SLL).
This article examines the similarities, differences, and possible connections between CLL and multiple myeloma.
CLL is the most common type of leukemia in adults in Western countries. The American Cancer Society (ACS) estimates that 20,700 people in the United States will receive a CLL diagnosis in 2024.
The term "chronic lymphocytic leukemia" describes how and where it develops. Chronic leukemias tend to develop slowly. Lymphocytic leukemias develop in a type of white blood cell called lymphocytes.
CLL develops in a specific type of lymphocyte in your bone marrow called B cells. Healthy B cells help your body fight infections, but leukemic B cells develop abnormally and can't fight infections in the same way.
As CLL progresses, your body makes more leukemic B cells that crowd out healthy blood cells. Having fewer healthy white blood cells weakens your immune system and makes you more prone to infections.
People with CLL often don't have symptoms in the early stages. In fact, about 50% to 75% of people with CLL don't have any symptoms at the time of diagnosis.
The exact cause of CLL is not known, but experts have identified several risk factors:
Multiple myeloma is a type of blood cancer that develops in plasma cells. Plasma cells are white blood cells that develop from B cells in response to an infection. They play an important role in your immune system due to their ability to produce antibodies, which are proteins that help your immune system recognize foreign invaders.
In people with multiple myeloma, abnormal plasma cells replicate abnormally and crowd out healthy blood cells.
The National Cancer Institute estimates there will be 35,780 new cases of multiple myeloma in 2024 in the United States.
It is unclear exactly why multiple myeloma develops, but it's thought to start when an abnormal plasma cell replicates more rapidly than it should.
Risk factors for developing multiple myeloma include:
CLL develops in B cells in your bone marrow. Multiple myeloma develops in plasma cells, which are B cells that become activated in response to an infection. Cancerous plasma cells produce a type of protein called M protein.
M protein buildup in people with multiple myeloma tends to cause "CRAB" symptoms:
Although both conditions cause many of the same symptoms, high levels of calcium and M proteins in multiple myeloma can cause unique symptoms such as vision problems, kidney failure, and confusion.
Here is an overview of the main differences between CLL and multiple myeloma:
Comments
Post a Comment