Dr Ermann on Data for Real-World Treatment Burdens in Older Patients with CLL

“The most interesting finding from the study was actually in the oldest patients. Those who were at least 80 years old, approximately 35% still need a second-line treatment…When you are putting an [older patient with CLL] on treatments do not be surprised if they need a second or third line.”

Daniel Ermann, MD, an associate professor in the Division of Hematology and Hematologic Malignancies and the physician lead of the Chronic Lymphocytic Leukemia (CLL) Clinical Trials Program at Huntsman Cancer Institute, discussed findings from a real-world, retrospective cohort study that evaluated treatment burdens among patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma who were at least 75 years of age, which were presented at 2026 EHA Congress.

Data from the study showed that among patients who were 75 to 79 years of age and at, 53.3% (95% CI, 50.3%-56.1%) underwent a second line of treatment; this rate was 34.4% (95% CI, 31.4%-37.4%) for those at least 80 years of age. A cumulative incidence of 45.5% (95% CI, 43.3%-47.8%) at 96 months was shown for patients included in a sensitivity analysis, examining outcomes for those who started first-line therapy between 2011 and 2022. Moreover, BTK inhibitors were the most common treatment given to patients in the frontline setting since 2014, in both the overall group and age subgroups.

Ermann began by highlighting data from the oldest cohort of patients, noting the 34.4% rate of patients at least 80 years of age receiving second-line treatment as the most striking from the study. These data are contrary to common belief, Ermann explained, especially considering the strong progression-free survival of common treatments like BTK inhibitors. He then emphasized the expectation of second or even third lines of therapy for older patients with CLL, underscoring how over half of these patients will require subsequent lines. Ultimately, Ermann concluded by adding that expectations of later lines of therapy should be upheld even patients who are older, frail, and have multiple comorbidities.