Specialist follow-up may be unnecessary for low-risk chronic leukemia
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Key takeaways:
- A large proportion of patients with asymptomatic low- to intermediate-risk CLL can safely end specialized follow-up.
- Patients who discontinue follow-up had fewer hospital visits per patient-year.
Individuals with low-risk chronic lymphocytic leukemia who exhibit no symptoms may no longer require specialized follow-up, according to study data published in Blood Advances.
The findings show that among asymptomatic patients with CLL, those who discontinued physician follow-up had fewer hospital visits and fewer infections, while also having similar 3-year survival rates compared with patients who continued to undergo specialized follow-up, researchers reported.
“We had expected patients to do as well without specialized follow up as with follow up; thus, it was a pleasant surprise that the patients had even lower risk for infections when stopping specialized follow-up,” Carsten Niemann, MD, PhD, chief physician in the department of hematology at Rigshospitalet and associate professor at University of Copenhagen, told Healio.
“This is obviously with the caveat that it is not a randomized trial, but to me it emphasizes that it is safe and feasible to stop specialized follow up for 20% to 40% of patients with CLL — it may even both improve quality of life and reduce risk for infections for the patients,” he added.” Thus, we can relieve the patients from the burden of hospital controls while improving prioritization of limited health care resources.”
Background, methods
Approximately one-half of patients with CLL will never require treatment for their condition but are still recommended specialized follow-up throughout their lives.
Researchers in Denmark conducted a study to assess feasibility and safety of ending specialized follow-up by evaluating 3-year clinical outcomes among 200 patients with CLL.
Of the study population, 112 selected by clinical assessment did not continue specialized follow-up as recommended, whereas 88 patients continued specialized follow-up care.
Patients who discontinued specialized follow-up during the study were older in age but exhibited lower risk compared with patients in the specialized care cohort.
Results
The analysis revealed similar OS in both cohorts, with a 3-year OS rate of 87% among patients who ended specialized follow-up and 80% among patients who continued specialized follow-up.
However, patients who ended specialized follow-up had fewer hospital visits per patient-year (median, 0.7 vs. 4.3) and longer time to first infection (P = .035); the results also showed shorter in-hospital antimicrobial treatment (median, 4 vs. 12 days) in favor of patients who discontinued follow-up.
Researchers also reported a lower 3-year first treatment rate among patients who discontinued follow-up (4%) compared with those who continued the recommended follow-up (23%).
Potential study limitations include lack of a randomized trial design, with researchers only selecting patients who met specific low-risk criteria for needing CLL treatment. Additionally, researchers conducted the study in Denmark where there is universal health care; therefore, the findings may not be generalizable to countries that have private health insurance.
Next steps
According to researchers, it is safe for asymptomatic patients with low to intermediate risk CLL without need of treatment to discontinue specialized follow-up.
“We are currently testing a set up where we send an electronic questionnaire to the patient along with an order for blood tests for low-risk patients — in this way we try to avoid the 16% of patients being re-referred after stopping specialized follow up, but providing them a way of having contact to the specialist, while not [having] to come to the hospital unless needed,” Niemann told Healio. “We have administrative personnel managing the questionnaires and blood test results by a rule-based algorithm, thus we can provide this set up with a minimum of physician time spent.”
For more information:
Carsten Niemann, MD, PhD, can be reached at carsten.utoft.niemann@regionh.dk.
References:
Brieghel C, et al. Blood Adv. 2024;doi:10.1182/bloodadvances.2023012382.
Study shows ‘feasibility’ of ending specialist follow-up in patients with low-risk CLL (press release). Available at: https://www.hematology.org/newsroom/press-releases/2024/study-shows-feasibility-of-ending-specialist-follow-up-in-patients-with-low-risk-cll. Published April 4, 2024. Accessed April 26, 2024.
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