HCL Patient Seminar

September 2014

Quality of Life Monica Else

Quality of life in chronic lymphocytic leukaemia

• Large trial of 777 patients from 136 centres in Argentina, Croatia, Greece, Ireland, Italy, New Zealand, Russia, UK

• Comparing 3 different treatments

• Self-assessed quality of life questionnaire

• 5-year follow-up

Quality of life in chronic lymphocytic leukaemia – results

Else et al, Leuk Lymphoma, 53: 1289-98; 2012

The coloured boxes denote a statistically significant difference between groups (10 points or more, p<0.01)

PF RF SF FA QL PF RF SF FA QL PF RF SF FA QL PF RF SF FA QL PF RF SF FA QL PF RF SF FA QL

Chlorambucil 80 73 79 34 66 78 74 78 31 68 77 73 74 33 67 76 74 76 33 66 76 71 75 34 66 75 69 74 35 63

Fludarabine (F) 80 75 79 31 66 81 75 79 30 68 81 76 82 33 66 76 69 79 36 64 79 74 77 35 67 78 73 78 36 64

F+Cyclo 82 77 81 32 68 80 77 81 28 70 83 76 82 27 72 80 76 77 31 67 76 73 76 37 64 77 73 76 32 68

Female 78 73 78 38 64 77 75 80 31 66 73 72 78 34 64 72 71 75 35 62 70 70 73 38 63 70 68 74 38 63

Male 81 75 80 31 67 80 75 78 30 69 81 76 78 31 69 79 74 78 33 67 79 73 77 34 67 79 72 77 33 65

Age <70 yrs 83 75 78 33 67 82 76 79 29 69 82 75 78 30 70 80 75 77 32 68 80 74 76 33 68 80 73 77 32 67Age ≥70 yrs 75 73 83 33 64 72 73 79 32 66 72 72 79 35 64 68 66 77 37 59 65 65 76 41 59 62 63 72 42 54

Symptomatic 73 64 72 40 59 74 71 75 34 64 76 73 76 34 66 75 69 76 36 63 74 69 74 36 64 73 67 74 37 62

Asymptomatic 84 80 83 29 70 82 77 81 28 71 80 75 79 31 69 78 75 77 32 67 78 73 77 35 67 77 72 77 34 65

Still in remission 81 79 83 27 71 83 81 84 26 72 82 79 85 28 71 83 82 85 27 72 84 80 86 25 69

Progressed 73 64 67 39 62 73 64 68 40 61 73 68 71 38 61 73 67 71 39 62 73 67 72 38 63

Year 4 Year 5Before treatment Year 1 Year 2 Year 3

Quality of life in leukaemia: the long term

What are the implications for HCL?

0 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 2 0

Ye a rs fro m s ta rt o f tre a tm e n t

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Comple te re sponse

Partial re sponse

p<0.0001

Duration of remission in HCL

Dearden et al, Leuk Lymphoma, 52(S2): 21-24; 2011

How do you make sure you have a CR?

• Bone marrow biopsy

• Further treatment if only a PR

Conclusions

• Having severe symptoms at the outset does not predict poor quality of life in the longer term

• Disease progression and relapse are associated with poor quality of life

• Long-term remission equates with good quality of life (“getting your life back”) and should be the aim of therapy