P122 | ULTRASOUND ASSESSMENT OF PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA TREATED WITH BTK INHIBITORS. CLINICAL AND PHARMACOECONOMIC IMPACT

Background. IWCC and ESMO guidelines (I&EGu) suggest abdominal ultrasound (US) and superficial lymphnodes (SLN) palpation to assess patients with chronic lymphocytic leukemia (CLL) in general practice. Computed tomography (CT) is generally not indicated out of a clinical trial. The CLL expert Tuscany panel included SLN ultrasound (SLUS) in general practice (GP). According to I&EGu progressive lymphadenopathy or splenomegaly are a sign of active disease. O’Brien et all, reported that lymphnodes dimensions have an impact on response to Ibrutinib (3). Materials and methods: we applied the US methodology previously published (1,2) to assess patients with CLL treated with BTK inhibitor (BTKi). US was previously published to be useful in a) in CLL SLN description (1), b) comparison of US vs palpation (Palp) (1) of SLN, and c) the expert CLL Tuscany guidelines (2). We applied US to the potential clinical benefit (PCB) and to the potential pharmacoeconomic impact I (PPhI) of BTKi treatment in multiple possible clinical scenarios (S). We define PPhI as positive (pos) when a right treatment is delivered with a right timing according to the I&EGu, and negative (neg) when a right treatment is potentially delivered with a wrong timing. The PCB and PPhI were analysed in different S. S1 and S2 refer to patients at diagnosis and during BTKi treatment, respectively. Results S1a: patients at diagnosis in follow up without treatment. If patients are treated too early there is not a PCB and a PPhI is neg (US vs Palp). S1b: if patients are treated too late with BTKi there is not a PCB and the PPhI is neg, because treatment response and time to next treatment (TTN) are expected to be sub-optimal, with a shorter TTNT. S2a: if patients are BTKi’s responsive (complete or partial remission (CR and PR)) the PCB is pos and the PPhI is pos (US vs Palp), S2b: if patients’ response to BTKi is erroneously considered lost, with a switch to a second line treatment, the PCB is neg and the PPhI is neg (US vs Palp). Conclusions: both the timing of initial BTKi treatment and the correct assessment of response to a BTKi is crucial for a PCB and a pos PPhI. US of SL might be a useful tool to assess CLL patients both at diagnosis and during follow up on a BTKi therapy helping physicians in general practice during clinical decision to obtain a PCB and a pos PPhI. References 1) doi: 10.3390/jcm11113206. 2) doi: 10.1007/s10238-023-01244-5