Patient-Reported QOL Outcomes of Initial CLL Treatments Highlighted at ASH 2024

New research presented in two abstracts at the 2024 American Society of Hematology (ASH) Annual Meeting & Exposition has shed light on patient-reported outcomes (PROs) in individuals receiving first-line treatment for chronic lymphocytic leukemia (CLL).

Financial Toxicity and Nonadherence A study involving 47 patients undergoing first-line oral oncolytic therapy (OOT) found that 51% received BTK inhibitors, mostly acalabrutinib and zanubrutinib (43%), while 53% received concurrent obinutuzumab. This research highlighted the risk of early and progressive financial toxicity and suboptimal adherence among these patients. The study suggested that assessing financial toxicity and nonadherence soon after OOT initiation is crucial, as these issues are significantly associated with inferior health-related quality of life (HRQOL).

Despite most patients having insurance coverage, significant financial toxicity was observed in 22%, 33%, and 28% of patients at baseline, 3 months, and 6 months, respectively. Financial toxicity was strongly associated with inferior HRQOL at all timepoints and with inferior medication adherence at baseline. Suboptimal OOT adherence was reported by 34%, 39%, and 48% of patients at baseline, 3 months, and 6 months, respectively.

Timing of QOL Improvements Varies Another study involving 863 participants from the phase 3 GAIA/CLL13 trial focused on patients taking venetoclax-based combinations for first-line CLL treatment. It found that improvements in QOL measures and key functioning scales occurred shortly after treatment initiation in patients treated with doublets, venetoclax-obinutuzumab (GV) or venetoclax-rituximab (RV). However, similar improvements in patients taking the triplet venetoclax-obinutuzumab-ibrutinib (GIV) were reported later after the end of treatment. Improvements were smaller and seen later for patients receiving chemoimmunotherapy (CIT).

The difference in the timing of QOL improvements between patients taking the triplet combination versus the doublets seems to be influenced by a higher symptom burden during GIV treatment. This factor should be considered when comparing efficacy outcomes of different venetoclax combinations in CLL.

Changes in functioning scales, global health status (GHS)/QOL, and symptoms were assessed using the EORTC QLQ-C30 and QLQ-CLL16 questionnaires. In the RV and GV arms, GHS improved after initiation of treatment, and mean changes from baseline above the minimal important difference (MID) were maintained throughout the study. In the GIV arm, no mean increase above the MID was observed during the first 12 months of treatment, but it was seen at month 15 when most patients had finished treatment. In the CIT arm, the first mean improvement above MID was reported at month 24.