A REAL-WORLD STUDY OF PATIENT DEMOGRAPHICS, CLINICAL CHARACTERISTICS AND THE TREATMENT PATTERNS OF CHRONIC LYMPHOCYTIC LEUKEMIA AND SMALL LYMPHOCYTIC LYMPHOMA IN BRAZIL

Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are B-cell malignancies in which dysfunctional mature B cells accumulate in the blood and bone marrow (CLL) or lymphoid tissues (SLL). There is limited evidence describing the profile and treatment (tx) of patients (pts) with CLL/SLL in Brazil in the real world. This study aimed to describe the demographics, clinical characteristics and tx patterns of pts with CLL/SLL in Brazil. Data were drawn from the Adelphi CLL Disease Specific Programme™, a cross-sectional survey with retrospective data collection from Sept 2022-Feb 2023 in 8 countries including Brazil. Hematologists/hem-oncologists provided demographic, clinical characteristic and tx data for 8 consecutively consulting pts with CLL/SLL in a 3:5 ratio of those currently receiving tx in first line (1L) vs. previously treated (2L+). Descriptive analyses for the Brazilian sample are presented. Physicians (n = 43) provided data for 348 pts with CLL/SLL. Most were hematologists (86%, n = 37/43) and based in an academic/specialty center (79%, n = 34/43), with 12% (n = 5/43) based in a general hospital and 9% (n = 4/43) elsewhere. Most pts (90%, n = 313/348) had a diagnosis of CLL, with a median age of 69.0 (interquartile range: 62.0, 75.0) years, 62% (n = 216/348) were male, and 18% (n = 63/348) had a caregiver. Most commonly, pts had an ECOG Performance Status 0-1 at data collection (82%, n = 287/348) and a CLL-International Prognostic Index (IPI) of intermediate (26%, n = 90/348) or high risk (33%, n = 114/348). IGHV (78%, n = 271/348) and TP53 (76%, n = 266/348) were the most common high- risk features tested for, with 49% (n = 133/271) unmutated for IGHV and 28% (n = 75/266) mutated for TP53. Del(17p) was tested in 45% of pts (n = 157/348). Complex karyotype was assessed in 12% (n = 43/348) of pts. The most common 1L txs (received alone or in combination) were FCR (29%, n = 100/348), ibrutinib (18%, n = 64/348) and acalabrutinib (8%, n = 29/348); some venetoclax-obinutuzumab use was observed (3%, n = 9). At 2L, the most common txs (alone or in combination) were ibrutinib (30%, n = 63/208), acalabrutinib (21%, n = 43/208) and venetoclax (18%, n = 38/208). For 1L tx initiated 2010-2019, ibrutinib (alone or in combination) was received by 11% (n = 9/80; known start date), and acalabrutinib by 3% (n = 2/80; known start date). For the period 2020-2023, ibrutinib was received by 20% (n = 39/198; known start date) and acalabrutinib by 12% (n = 23/198; known start date). Overall, 57% (n = 200/348) of pts ever received a BTKi; 20% (n = 40/200) received a tx post-BTKi. For pts who received a BTKi (alone or in combination) at 1L, overall response rate (ORR) was 62% (n = 56/90); the same for those who received chemotherapy/chemoimmunotherapy (62%, n = 134/215). At 2L, respective ORR was 68% (n = 73/108) and 41% (n = 18/44). This real-world population in Brazil reflects the typical age and male predominance of CLL/SLL pts, with variable rates of high-risk genetic testing. Recent years have seen a clear shift in tx patterns toward targeted therapies, particularly BTKi, though earlier approval dates vs. BCL2i may have influenced this. These findings suggest the increasing adoption of novel agents. The relatively low proportion of pts with a caregiver highlights a need for txs with low burden of administration and monitoring.