Study Suggests Patients With Low-Risk CLL May Stop Specialized Follow-Up Visits

According to findings published in Blood Advances, compared with those who have to undergo specialized follow-up, patients who have slow-growing chronic lymphocytic leukemia (CLL) without any symptoms and a low risk of ever needing treatment who stopped seeing their specialized follow-up (sFU) physicians had fewer hospital visits, fewer infections, and similar survival after 3 years.¹

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CLL is the most common blood cancer in adults, but it can either be slow-moving or incredibly aggressive. When aggressive, the disease requires immediate treatment; however, indolent CLL can be stable for years without any treatment. Prior research has indicated that approximately 3 in 10 patients with CLL never need treatment; however, these patients still have to undergo years of sFU visits that, according to researchers, include exams and blood tests that may cause distress.¹

“To the best of our knowledge, [the current study] is the first of what happens when specialist follow-up for CLL is stopped,” said senior study author Carsten Niemann, MD, PhD, associate professor at the University of Copenhagen, chief physician, department of hematology at Rigshospitalet in Copenhagen, Denmark, in a press release.¹

To evaluate the safety of ending sFU visits, the study authors investigated 112 patients with CLL who ended sFUs and compared their clinical outcomes after 3 years with 88 patients who continued sFUs. The patients who stopped sFUs were advised to get vaccinated for pneumonia and influenza as well as contact their primary care providers if they experienced symptoms such as fever, chill, night sweats, weight loss, or infection. The patients who continued sFUs underwent periodic follow-up visits that included physical exams and blood tests with their hematologists.^1,2

The data were retrieved from patients who never received CLL treatment. Patients who had disease characteristics which indicated a high or very high risk of requiring treatment were not included in the study. The primary end point was 3-year overall survival (OS), and secondary end points included hospital contacts, the time since developing first infection, 3-year rate of re-referral to a hematologist, and the time to needing the first treatment for CLL. Patients were recruited from a Denmark institution.¹

According to the findings, OS was not significantly different between the 2 patient groups at 3 years (Ending sFUs: 87%; Continuing sFUs: 80%; P = .16). In addition, 19 patients (16%) in the discontinued group were re-referred to their hematologists, and among these patients, 3 chose to discontinue follow-up care again and 12 continued sFUs, whereas 4 received treatment for their CLL. During the follow-up period, 14 patients in the discontinued group and 19 in the continued group died; however, causes of death appeared unrelated to CLL and included infections, other cancer types, heart disease, trauma, and Alzheimer disease.^1,2

Further, among 2811 total hospital contacts, 873 visits (31%) and 1938 visits (69%) were from patients who ended and continued sFUs, respectively (median 0.7 vs 4.3, P < 0.0001). Time to first infection was longer (P = .035) for patients who ended sFU compared with those who continued, and this also included fewer COVID-19 infections (8 [7%] vs 17 [18%]; P = .029) and shorter in-hospital antimicrobial treatment (median 4 vs 12 days, respectively; P = .026). Additionally, approximately 45% of the patients who discontinued sFUs developed infections that were treated with antibiotics compared with 51% of those who continued sFUs.²

“We have demonstrated that more than half of patients with low to intermediate risk for ever needing CLL treatment may safely be selected to stop sFU,” said first study author Christian Brieghel, MD, PhD, postdoctoral hematology fellow, Rigshospitalet, in the press release. “They had lower use of hospital and health care resources, a lower frequency of infections, and if they had an infection, they were hospitalized for a shorter time, and their OS was comparable to similar patients who continued sFU.”¹

The study authors note that the study not being randomized was a limitation. Rather than randomly selecting patients, participants were chosen based on specific low-risk criteria for needing CLL treatment. Further, the authors note that because health care in Denmark is free at the point of care, all patients who discontinued sFUs and developed symptoms of CLL were re-referred to a hematologist by their primary care provider, and therefore the study results are not generalizable to other countries.¹

“Our findings show that it’s feasible to discontinue sFU in patients who have a very low risk of needing CLL treatment and that doing so does not cause these patients any harm,” said Niemann in the press release.¹

References

1. American Society of Hematology. Study shows “feasibility” of ending specialist follow-up in patients with low-risk CLL. News release. April 4, 2024. Accessed April 4, 2024. https://www.eurekalert.org/news-releases/1039854#:~:text=%E2%80%9CWe%20have%20demonstrated%20that%20more,and%20the%20study's%20first%20author.

2. Brieghel, B, da Cunha-Bang, C, Mourek, J, Kjeldsen, L, Niemann, C. It is feasible and safe to stop specialized follow-up of asymptomatic lower risk chronic lymphocytic leukemia. Blood Adv 2024 doi:10.1182/bloodadvances.2023012382