P118 | Real-world Outcomes in Chronic Lymphocytic Leukemia: a 12-year Single-center Experience
Year: 2025
Type: article
Abstract: Introduction Over the past decade, therapeutic strategies for Chronic Lymphocytic Leukemia (CLL) have undergone a profound transformation, shifting from chemoimmunotherapy to targeted agents. Personalized treatment approaches based on clinical and molecular features have been standardized, particularly in elderly and those with comorbidities. However, real-world data on treatment sequencing and outcomes are still limited and sometimes controversial. Methods We conducted a retrospective, single-center, real-world study on 230 consecutive CLL patients treated at the Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy, between July 2011 and June 2023. Patients received a diagnosis of CLL according to international guidelines, and treatment was initiated based on iwCLL criteria. Therapeutic decisions were individualized, considering clinical status, comorbidities, cytogenetics, molecular profile, and patient preference. First-line therapy was administered in 51% of patients: 65% of them received standard chemoimmunotherapy, while 35% of cases were treated with targeted agents (mainly ibrutinib, or venetoclax+obinutuzumab). A second line treatment was required in 31% of patients. Hematologic responses were evaluated as per iwCLL criteria. Follow-up included flow cytometry immunophenotyping monitoring every 3-6 months. Outcomes were time-to-treatment initiation (TTI), time to next treatment (TTNT), progression-free survival (PFS), and overall survival (OS). Results Patients treated with standard chemoimmunotherapy showed a higher overall response rate (ORR) in first-line settings (70%) compared to those treated with targeted agents (30%), although a trend toward improved OS was observed in patients receiving targeted therapies. CD38 and CD49d expression emerged as relevant prognostic factor, as their co-expression was significantly associated with shorter PFS, particularly in patients treated with BTKi or BCL2i. Conversely, a CD38-CD49d- immunophenotype was linked to a favorable prognosis and significantly higher 5-year OS in patients receiving targeted therapies compared to chemoimmunotherapy (100% vs. 46%; p=0.0181). Conclusion Our real-world data confirm the importance of integrating clinical, biological, and immunophenotypic markers, like CD38 and CD49d, to guide personalized treatment strategies in CLL, even in elderly and/or frail patients, optimizing outcomes in routinely clinical practice.
Authors: L. Mettivier, D. De Novellis, B. Serio, L. Pezzullo, R. Guariglia, I. Ferrara, R. Fontana, M.C. Martorelli, S. Luponio, M. Buonanno, R. Marcucci, A. Malandrini, G. Signorile, L. Settembre, A. Gigantiello, I. Conversano, D. Morini, M. Rizzo, A.M. Della Corte, E. Selleri, P. Scala, M. Gorrese, A. Bertolini, A. Campana, M. Langella
Language: English
Subfield: Genetics
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7093122608
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