My daughter is currently the registrar in charge of lymphomas at Oxford. She tells me that the most difficult-to-treat patients are the refractory CLLs, even though she has to manage Burkitt's lymphoma and other high grade lymphomas as well as patients having autografts. In the journal, Value in Health, there is an article written to describe the current pattern of care and resource utilisation in Europe for patients with fludarabine-refractory chronic lymphocytic leukaemia (CLL) who are either refractory to alemtuzumab (DR) or ineligible for alemtuzumab due to bulky lymphadenopathy (BFR)
Data are from an interim analysis of 37 patients, 62% (n=23) DR and 38% (n=14) BFR. Median time between first diagnosis and index refractory diagnosis was 5.2 years. Average age was 62.2 (range 41-77), 76% were male and average number of co-morbidities was 2.2. Many patients (59%) died during the post index period with median survival following diagnosis of refractory disease being 6.2 months. In the pre-index period the average number of pharmacotherapy regimens was 0.9 (range 0-3) and in the post-index period 1.4 (range 1-4). During the 24 month review period the most frequent single agent regimens were alemtuzumab (38% patients) and methylprednisolone (19%). Patients receiving combination therapy most frequently received rituximab (43%), mainly in combination with CHOP (16%), fludarabine/cyclophosphamide (11%), and bendamustine (8%). 89% of patients experienced at least one treatment related adverse event, including infection (76%), anaemia (76%), thrombocytopenia (68%) and neutropenia (62%). Average number of post-index A&E visits was 0.8 and in-patient stays 1.9, the majority (86%) relating to CLL or its treatment. Average inpatient stay was 11.2 days. Most patients (81%) had multiple diagnostic investigations (average 11.5), predominantly CT scans (average 6.1) and X-rays (average 2.0).
This study demonstrates the high economic burden and continuing unmet clinical needs of patients with fludarabine-refractory CLL disease in Europe