The authors wrote, “The vast majority of patients with newly diagnosed chronic lymphocytic leukemia (CLL) present without an indication for treatment and are typically followed by standard-of-care (SOC) watch and wait (WW) until CLL progression or death.”
The study’s objective was to examine the practicability and safety of discontinuing specialized follow-up (sFU) in asymptomatic patients with lower-risk CLL and evaluate the impact of this approach on overall survival, hospital admission rates, and infection rates.
The study included 200 asymptomatic patients with untreated CLL who had low- or intermediate-risk disease according to the prognostic model, CLL-WONT, and prognostic index, CLL-IPI. Most patients (n = 125) were considered low risk, and 75 were considered intermediate risk. A total of 112 patients ended sFU after a median of 4.2 years, and the remaining 88 patients continued sFU.
The primary outcome of this study was 3-year overall survival (OS), and secondary outcomes included healthcare utilization measured as hospital contacts, time to first infection, duration of infections, 3-year rereferral rate, and time to first treatment.
The results revealed that patients who ended follow-up were older, had lower absolute lymphocyte counts, and more commonly had mutated immunoglobulin heavy-chain variable region gene status compared with those who continued follow-up (P ≤.0058). As a result, these patients were classified as lower-risk according to the CLL-WONT and CLL-IPI scores (P <.0001).
Patients were followed for an average of 3.7 years after ending follow-up, and the 3-year OS was 87% for those who ended sFU and 80% for those who continued. For patients with low-risk disease per CLL-WONT, the 3-year OS rate was 90% for those who ended follow-up and 94% for those who continued. The 3-year OS rates among intermediate-risk patients were 67% and 70%, respectively.
Moreover, patients who terminated follow-up had fewer hospital visits, with 873 visits (31%) compared with 1,938 visits (69%) for those who continued (P <.0001), and the average median number of hospital visits per patient-year was meaningfully lower for those who ended follow-up (0.7) compared with those who continued (4.3; P <.0001).
Based on in-hospital antimicrobial use, 35% of patients who ended follow-up experienced an infection, and 51% of those who continued follow-up. The time to first infection was significantly longer for patients who ended sFU, and the duration of in-hospital infections was shorter for these patients, reported as 4 days, compared with those who continued follow-up, reported as 12 days.
The authors wrote, “Demonstrating similar survival in CLL-WONT low and intermediate patients with CLL ending or continuing sFU, we provide evidence that patients with CLL-WONT and CLL-IPI low-to-intermediate risk could safely end sFU in a public health system with general access to general practitioner care.”
The authors noted that over one-half of patients classified as treatment-naïve with both CLL-IPI and CLL-WONT low-to-intermediate risk may safely be selected to end sFU, and these patients had fewer hospital visits and infections without affecting OS. Moreover, the majority of the patients did not need to return for treatment within 3 years and exhibited no disease progression. Appropriate patients were identified as having TP53 wild-type CLL with a CLL-IPI and CLL-WONT score of up to 3 points.
The authors concluded that it is reasonable and safe to end sFU in patients with CLL who have low-to-intermediate–risk CLL-IPI and CLL-WONT scores upon detailed clinical evaluation before ending sFU.
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