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Changes in first-line treatment patterns according to frailty in chronic lymphocytic leukemia/small lymphocytic lymphoma
Journal article   Peer reviewed

Changes in first-line treatment patterns according to frailty in chronic lymphocytic leukemia/small lymphocytic lymphoma

Vanessa E Slater, Ryan M Carnahan, Christopher S Strouse, Michael A O'Rorke, Brian J Smith and Elizabeth A Chrischilles
Leukemia & lymphoma, Vol.66(11), pp.2078-2089
09/19/2025
DOI: 10.1080/10428194.2025.2522373
PMCID: PMC12259026
PMID: 40569700
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC12259026/View
Open Access

Abstract

Novel therapies have transformed treatment for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), but how they have changed treatment for frail patients is unclear. Using Surveillance, Epidemiology, and End Results-Medicare data, we conducted a nested case-control analysis to evaluate the influence of frailty, measured with Function-Related Indicators (FRIs), on first-line treatment initiation. Four FRIs were positively associated and seven were negatively associated with treatment initiation, representing CLL/SLL symptoms and general frailty, respectively. During the chemoimmunotherapy era (2006-2013), patients with general frailty were significantly less likely to initiate treatment (aOR for 1 FRIs: 0.86, 95% CI 0.77-0.96; 2 FRIs: 0.83, 95% CI 0.70-0.98; ≥3 FRIs: 0.55, 95% CI 0.0.44-0.68 versus 0 FRIs). By 2019, this relationship diminished (p =0.031) with only the frailest patients less likely to initiate treatment (≥3 FRIs versus 0 aOR: 0.62, 95% CI: 0.41-0.99). This suggests disparities by frailty in first-line treatment initiation dissipated as novel therapies were approved.
Comorbidity frailty Chronic lymphocytic leukemia treatment patterns novel therapies

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