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Chronic Lymphocytic Leukemia: Real-World Data From India.

V Tejaswi1, Deepesh P Lad1, Nishant Jindal1

  • 1Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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|June 25, 2020
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Summary

Indian patients with chronic lymphocytic leukemia (CLL) are younger but have higher morbidity. Fixed-dose biosimilar bendamustine + rituximab (BR) shows comparable outcomes to literature, while chlorambucil remains a viable, cost-effective option for CLL treatment.

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Area of Science:

  • Hematology
  • Oncology
  • Clinical Research

Background:

  • Chronic lymphocytic leukemia (CLL) is relatively uncommon in India, with limited published data from the region.
  • Understanding the characteristics and treatment outcomes of Indian CLL patients is crucial for optimizing care.

Purpose of the Study:

  • To prospectively evaluate the diagnosis, prognosis, treatment indications, response, and adverse events in Indian patients with CLL.
  • To assess the efficacy and safety of front-line therapies, including chlorambucil and bendamustine + rituximab (BR), in this population.

Main Methods:

  • A prospective study of 409 consecutively diagnosed CLL patients from 2011-2017 at a single center.
  • Data collection followed International Workshop on Chronic Lymphocytic Leukemia guidelines, including assessment of Time to Next Treatment (TTNT) and Overall Survival (OS).
  • Fixed-dose (375 mg/m²) biosimilar rituximab was used in combination regimens.

Main Results:

  • The median age of patients was 61 years, with a significant proportion (31.8%) aged ≤ 55 years.
  • Chlorambucil and BR were the most common front-line regimens. Overall response rates were 74.4% for chlorambucil and 91.2% for BR.
  • TTNT was significantly longer with BR (not reached) compared to chlorambucil (33 months) (P=.001). Grade 3/4 neutropenia and infections were more frequent with BR.

Conclusions:

  • Indian CLL patients tend to be younger but present with a higher comorbidity burden.
  • Treatment outcomes with fixed-dose biosimilar BR are comparable to international data.
  • Chlorambucil remains a valid and potentially more economical treatment option for CLL in India.