Survival Outcomes in Chronic Lymphocytic Leukemia Patients

Survival Outcomes in Chronic Lymphocytic Leukemia Patients


For a study, researchers sought to see if patients with chronic lymphocytic leukemia (CLL) who were treated at Commission on Cancer accredited academic centers (ACs), which had a high clinical volume, access to clinical trials, and postgraduate physician education, had a better prognosis than those who were treated at non-academic centers (NACs). CLL patients diagnosed between 2004 and 2018 were identified using the National Cancer Database (NCDB). Binary logistic regression was used to evaluate demographic and therapeutic features between center types for the probabilities of receiving CLL therapy at an AC. Kaplan Meier and multivariate Cox regression compared overall survival (OS), corrected for the only disease-related factors available in the NCDB, age, and Charlson-Deyo comorbidity score. The results showed that 33.3% of the 98,186 patients were treated at ACs. Patients who received ACs were younger than those who received NACs (median age 67 vs. 71, P<0.001). ACS were more likely to treat Black and other minority patients, with Black patients accounting for 9.7% of AC patients compared to 6.3% of NAC patients (P<0.001). When comparing the highest quartiles of income (OR 1.46), and education (OR 1.12), we’re more likely than NACs to treat privately insured (39.1% vs. 30.3%), uninsured (3.2% vs. 2.0%), and Medicaid patients (4.1% vs. 2.9%) (P<0.001), as well as patients from the highest quartiles of income (OR 1.46), and Medicaid patients (4.1% vs. 2.9%). Compared to NACs, ACs were more likely to handle patients with surveillance (53.7% vs. 45%, P<0.001). When compared to NACs, the median OS at ACs was considerably better, with 11.0 years (CI 10.5-11.3) vs. 8.2 years (CI 8.1-8.3), respectively (P<0.001). Both the 5-year (73% vs 66%) and 10-year (53% vs 43%) survival benefits were sustained (both P<0.001). Management of CLL patients at ACs was an independent predictor for the better OS on multivariate analysis adjusted for age and comorbidities (HR 0.87, CI 0.85-0.89, P<0.001). There was significant demographic and socioeconomic heterogeneity between CLL patients treated at ACs and NACs in this study of a large group of CLL patients. The improved OS benefit of CLL patients managed at ACs suggested possible differences in treatment, clinical trial availability, and supportive care management. While the study was limited by the available disease and treatment level data, the improved OS benefit of CLL patients managed at ACs suggests possible differences in treatment and clinical trial availability and supportive care management. More research into the factors contributing to such discrepancies would be desirable to standardize care and improve results.



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