Epidemiology, longitudinal treatment patterns and outcomes of chronic lymphocytic leukemia in Israel

Abstract

This study aims to describe chronic lymphocytic leukemia (CLL) epidemiology, treatment patterns and outcomes in a 2.3-million-member healthcare provider database (Maccabi Healthcare Services, Israel). Newly-diagnosed CLL patients (1999–2017) were followed through 31/3/2018. A total of 1857 newly-diagnosed CLL patients were included. Annual incidence was 5.82 per 100,000 population. Median overall survival (OS) was 12.7 (95%CI: 11.8–13.5) years since diagnosis. Approximately 1/3 initiated treatment within 5 y. A statistical trend (p = 0.066) for improved OS over time was observed among younger patients (age <70 y) treated in 2009–2017 vs. 1999–2008). Among patients treated since 2009 (n = 411; median age = 68y), fludarabine–cyclophosphamide–rituximab (FCR), bendamustine–rituximab and obinutuzumab ± chlorambucil accounted for 19.5%, 12.2% and 11.4% of first line, respectively. Median (95%CI) time to next treatment and OS were 3.1(2.6–3.6) and 7.0(6.3–7.7) years, respectively. CLL incidence in Israel is comparable to developed countries. Real-world data suggest a trend of improved survival over the last decade among patients treated before age 70.

Keywords:

• Chronic lymphocytic leukemia
• incidence
• survival
• time to next treatment
• immunotherapy
• chemotherapy

Acknowledgements

The authors wish to acknowledge and thank Maccabi Healthcare Services and AbbVie for their overall support and for forming a real-world research collaboration in order to generate and develop the data for this abstract.

Disclosure statement

Clara Weil, Prof. Gabriel Chodick and Prof. Varda Shalev do not have any conflict of interest. Prof. Yair Herishanu has served as a consultant to AbbVie, and has received research funding and speaker fees from AbbVie. Dr. Inna Kan, Dr. Kavita Sail and Dr. Raanan Cohen are employees of AbbVie and own AbbVie stock. Dr. Ran Afik is a former AbbVie employee.

All authors participated in study design and/or analysis and/or interpretation of the data. Clara Weil drafted the manuscript and all authors critically revised the manuscript and approved the final version.

Additional information

Funding

This work was supported by an Abbvie institutional grant to Maccabi Healthcare Services.