The Impact of Age on Survival in CLL Patients Receiving Ibrutinib as Initial Therapy

Chaitra Ujjani, 1 Anthony Mato, 2 Brian T Hill, 3 John N Allan, 4 Erick Lansigan, 5 Ryan Jacobs, 6 Hande Tuncer, 7 John Pagel, 8 Danielle Brander, 9 Bruce Cheson, 10 Paul Barr, 11 Lindsey E Roeker, 2 Jeffrey Pu, 12 Nirav N Shah, 13 Andre Goy, 14 Stephen J Schuster, 15 Nicole Lamanna, 16 Alison Sehgal, 17 Constantine S Tam, 18 Mazyar Shadman 1 1Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; 2Division of Hematological Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; 3Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA; 4Division of Hematology and Medical Oncology, New York Presbyterian & Weill Cornell, New York, NY, USA; 5Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; 6Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Charlotte, NC, USA; 7Lowell General Hospital, Tufts Medical Center, Boston, MA, USA; 8Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA, USA; 9Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA; 10Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA; 11Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA; 12Division of Hematology/Oncology, SUNY Upstate Medical University, Syracuse, NY, USA; 13Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI, USA; 14John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA; 15Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA; 16Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA; 17University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 18Peter McCallum Cancer Centre, University of Melbourne, East Melbourne, VI, AustraliaCorrespondence: Chaitra UjjaniSeattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, 825 Eastlake Ave E, Mail Stop CE3-300, Seattle, WA, USATel +1 206-606-1955Fax +1 206-606-1130Email ujjani@uw.eduIntroduction: Recent randomized trials have demonstrated the efficacy of ibrutinib-based therapy in the treatment of patients with CLL. In Alliance A041202, a higher than expected number of unexplained deaths were reported with front-line ibrutinib in a patient population aged at least 65 years compared to ECOG 1912, which included patients up to 70 years of age.Methods: Therefore, we conducted a retrospective analysis to investigate whether ibrutinib was associated with a greater mortality in older patients outside of a clinical trial setting. This multicenter analysis was performed by investigators at 20 academic and community practices.Results: Amongst the 391 patients included, there was no correlation between age and response rate, PFS, or OS. However, there was a trend to higher rate of deaths in patients > 65-years-old (8.7% vs 3.8%, p=0.097), with an increased number of early deaths (13 vs 4, p=0.3).Conclusion: These data suggest greater intolerance, and possibly mortality, with ibrutinib in an older population. Patients should be educated regarding the potential complications related to ibrutinib and symptoms of concern to report.Keywords: CLL, ibrutinib, elderly