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Published in: Current Hematologic Malignancy Reports 2/2024

01-02-2024 | Ibrutinib

How Do We Manage Chronic Lymphocytic Leukemia in India

Authors: Parathan Karunakaran, Nidhi Jain, Deepesh P. Lad

Published in: Current Hematologic Malignancy Reports | Issue 2/2024

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Abstract

Purpose of Review

Chronic lymphocytic leukemia was an ignored leukemia in India until a decade back, given its low prevalence and absence of novel drugs to treat it. Healthcare in India is heterogeneous, with variations in population, health systems, and reimbursement options. We have focused on opinions from three hemato-oncologists incorporating an opinion poll from 44 hemato-oncologists across India on the common issues in CLL to give an idea of the practice pan-India.

Recent Findings

More CLL patients are being diagnosed in their early stages. There is an attempt to use prognostic and predictive markers in making shared decisions for managing CLL. There is still a role for chemoimmunotherapy (CIT) in India, given limited health insurance coverage. But with the availability of inexpensive generics, the patient preference for non-CIT options like Bruton’s tyrosine kinase (BTK) inhibitors is palpable.

Summary

The CLL scene in India is changing rapidly. With the wide availability of economical generic small molecule inhibitors, monoclonal antibodies, and coverage by social health insurance schemes, India is poised to cater to most CLL patient needs.
Literature
1.
go back to reference Gogia A, Sharma A, Raina V, Kumar L, Gupta R, Kumar R. An overview of young chronic lymphocytic leukemia patients: a single centre experience of 117 cases from Northern India. Ann Oncol. 2012;23:ix358.CrossRef Gogia A, Sharma A, Raina V, Kumar L, Gupta R, Kumar R. An overview of young chronic lymphocytic leukemia patients: a single centre experience of 117 cases from Northern India. Ann Oncol. 2012;23:ix358.CrossRef
2.•
go back to reference Tejaswi V, Lad DP, Jindal N, et al. Chronic lymphocytic leukemia: real-world data from India. JCO Glob Oncol. 2020;6:866–72. This paper included the largest series of CLL patients from India. This included clinical data of 409 patients and outcomes in the chemoimmunotherapy era.CrossRefPubMed Tejaswi V, Lad DP, Jindal N, et al. Chronic lymphocytic leukemia: real-world data from India. JCO Glob Oncol. 2020;6:866–72. This paper included the largest series of CLL patients from India. This included clinical data of 409 patients and outcomes in the chemoimmunotherapy era.CrossRefPubMed
3.
go back to reference Gunawardana C, Austen B, Powell JE, et al. South Asian chronic lymphocytic leukemia patients have more rapid disease progression than White patients. Br J Hematol. 2008;142(4):606–9.CrossRef Gunawardana C, Austen B, Powell JE, et al. South Asian chronic lymphocytic leukemia patients have more rapid disease progression than White patients. Br J Hematol. 2008;142(4):606–9.CrossRef
4.
go back to reference Lad DP, Tejaswi V, Malhotra P, et al. Establishment of a comprehensive chronic lymphocytic leukemia clinic at a tertiary referral center in India. Blood Adv. 2018;2(Suppl 1):33–4.CrossRefPubMedPubMedCentral Lad DP, Tejaswi V, Malhotra P, et al. Establishment of a comprehensive chronic lymphocytic leukemia clinic at a tertiary referral center in India. Blood Adv. 2018;2(Suppl 1):33–4.CrossRefPubMedPubMedCentral
5.
go back to reference Srinivasan VK, Naseem S, Varma N, Lad DP, Malhotra P. Genomic alterations in chronic lymphocytic leukemia and their correlation with clinico-hematological parameters and disease progression. Blood Res. 2020;55(3):131–8.CrossRefPubMedPubMedCentral Srinivasan VK, Naseem S, Varma N, Lad DP, Malhotra P. Genomic alterations in chronic lymphocytic leukemia and their correlation with clinico-hematological parameters and disease progression. Blood Res. 2020;55(3):131–8.CrossRefPubMedPubMedCentral
6.
go back to reference Lad DP, Tejaswi V, Jindal N, et al. Modified CLL International Prognostic Index (CLL-LIPI) using lymphocyte doubling time (LDT) in place of IgHV mutation status in resource-limited settings predicts time to first treatment and overall survival. Leuk Lymphoma. 2020;61(6):1512–5.CrossRefPubMed Lad DP, Tejaswi V, Jindal N, et al. Modified CLL International Prognostic Index (CLL-LIPI) using lymphocyte doubling time (LDT) in place of IgHV mutation status in resource-limited settings predicts time to first treatment and overall survival. Leuk Lymphoma. 2020;61(6):1512–5.CrossRefPubMed
7.
go back to reference Rani L, Gogia A, Singh V, et al. Comparative assessment of prognostic models in chronic lymphocytic leukemia: evaluation in an Indian cohort. Ann Hematol. 2019;98(2):437–43.CrossRefPubMed Rani L, Gogia A, Singh V, et al. Comparative assessment of prognostic models in chronic lymphocytic leukemia: evaluation in an Indian cohort. Ann Hematol. 2019;98(2):437–43.CrossRefPubMed
8.
go back to reference Gogia A, Gupta R, Sharma A, Kumar L, Rani L, Mallick S. Safety and efficacy of bendamustine and rituximab (BR) regimen in Indian chronic lymphocytic leukaemia patients. Indian J Hematol Blood Trans. 2023;39(1):33–9.CrossRef Gogia A, Gupta R, Sharma A, Kumar L, Rani L, Mallick S. Safety and efficacy of bendamustine and rituximab (BR) regimen in Indian chronic lymphocytic leukaemia patients. Indian J Hematol Blood Trans. 2023;39(1):33–9.CrossRef
9.
go back to reference Mato A, Nabhan C, Kay NE, et al. Prognostic testing patterns and outcomes of chronic lymphocytic leukemia patients stratified by fluorescence in situ hybridization/cytogenetics: a real-world clinical experience in the Connect CLL Registry. Clin Lymphoma Myeloma Leuk. 2018;18(2):114-124.e112.CrossRefPubMed Mato A, Nabhan C, Kay NE, et al. Prognostic testing patterns and outcomes of chronic lymphocytic leukemia patients stratified by fluorescence in situ hybridization/cytogenetics: a real-world clinical experience in the Connect CLL Registry. Clin Lymphoma Myeloma Leuk. 2018;18(2):114-124.e112.CrossRefPubMed
10.•
go back to reference Mato A, Nabhan C, Kay NE, et al. Real-world clinical experience in the Connect: chronic lymphocytic leukaemia registry: a prospective cohort study of 1494 patients across 199 US centres. Br J Haematol. 2016;175(5):892–903. This large real-world registry data described the clinical, demographic, and practice patterns for CLL management in the US. This described the infrequent use of genetic prognostic testing and differences in outcomes using chemoimmunotherapy in real-world settings.CrossRefPubMedPubMedCentral Mato A, Nabhan C, Kay NE, et al. Real-world clinical experience in the Connect: chronic lymphocytic leukaemia registry: a prospective cohort study of 1494 patients across 199 US centres. Br J Haematol. 2016;175(5):892–903. This large real-world registry data described the clinical, demographic, and practice patterns for CLL management in the US. This described the infrequent use of genetic prognostic testing and differences in outcomes using chemoimmunotherapy in real-world settings.CrossRefPubMedPubMedCentral
11.•
go back to reference Youron P, Singh C, Jindal N, et al. Quality of life in patients of chronic lymphocytic leukemia using the EORTC QLQ-C30 and QLQ-CLL17 questionnaire. Eur J Haematol. 2020;105(6):755–62. This study showed that the quality of life of CLL patients on wait-and-watch was severely affected and that patients on ibrutinib had a better QoL than those on chemoimmunotherapy. Youron P, Singh C, Jindal N, et al. Quality of life in patients of chronic lymphocytic leukemia using the EORTC QLQ-C30 and QLQ-CLL17 questionnaire. Eur J Haematol. 2020;105(6):755–62. This study showed that the quality of life of CLL patients on wait-and-watch was severely affected and that patients on ibrutinib had a better QoL than those on chemoimmunotherapy.
12.•
go back to reference Singh C, Jindal N, Youron P, et al. Efficacy, safety, and quality of life of generic and innovator ibrutinib in Indian CLL patients. Indian J Hematol Blood Trans. 2021;37(2):313–7. This is the first study showing the comparable safety and efficacy of generic and innovator ibrutinib.CrossRef Singh C, Jindal N, Youron P, et al. Efficacy, safety, and quality of life of generic and innovator ibrutinib in Indian CLL patients. Indian J Hematol Blood Trans. 2021;37(2):313–7. This is the first study showing the comparable safety and efficacy of generic and innovator ibrutinib.CrossRef
13.•
go back to reference Hegde NC, Kumar A, Kaundal S, et al. Generic ibrutinib a potential cost-effective strategy for the first-line treatment of chronic lymphocytic leukaemia. Ann Hematol. 2023;102(11):3125–32. This study showed that generic ibrutinib was cost-effective compared to chemoimmunotherapy at current prices. Hegde NC, Kumar A, Kaundal S, et al. Generic ibrutinib a potential cost-effective strategy for the first-line treatment of chronic lymphocytic leukaemia. Ann Hematol. 2023;102(11):3125–32. This study showed that generic ibrutinib was cost-effective compared to chemoimmunotherapy at current prices.
14.
go back to reference Lad DP, Malhotra P, Khadwal A, Prakash G, Jain A, Varma S. Reduced dose ibrutinib due to financial toxicity in CLL. Indian J Hematol Blood Trans. 2019;35(2):260–4.CrossRef Lad DP, Malhotra P, Khadwal A, Prakash G, Jain A, Varma S. Reduced dose ibrutinib due to financial toxicity in CLL. Indian J Hematol Blood Trans. 2019;35(2):260–4.CrossRef
15.
go back to reference Gogia A, Gupta R, Sharma A, Kumar L, Raina V, Rani L. Chronic lymphocytic leukemia: an Indian experience. J Clin Oncol. 2019;37(15_suppl):e19007–e19007.CrossRef Gogia A, Gupta R, Sharma A, Kumar L, Raina V, Rani L. Chronic lymphocytic leukemia: an Indian experience. J Clin Oncol. 2019;37(15_suppl):e19007–e19007.CrossRef
16.
go back to reference Jindal N, Lad DP, Malhotra P, et al. Randomized controlled trial of individualized, low dose, fixed duration lenalidomide maintenance versus observation after frontline chemoimmunotherapy in CLL. Leuk Lymphoma. 2021;62(7):1674–81.CrossRefPubMed Jindal N, Lad DP, Malhotra P, et al. Randomized controlled trial of individualized, low dose, fixed duration lenalidomide maintenance versus observation after frontline chemoimmunotherapy in CLL. Leuk Lymphoma. 2021;62(7):1674–81.CrossRefPubMed
17.••
go back to reference Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018;131(25):2745–60. This is the last updated clinical guidelines for the management of CLL by the International Workshop on CLL.CrossRefPubMed Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018;131(25):2745–60. This is the last updated clinical guidelines for the management of CLL by the International Workshop on CLL.CrossRefPubMed
18.
go back to reference Cuneo A, Follows G, Rigolin GM, et al. Efficacy of bendamustine and rituximab as first salvage treatment in chronic lymphocytic leukemia and indirect comparison with ibrutinib: a GIMEMA, ERIC and UK CLL FORUM study. Haematologica. 2018;103(7):1209–17.CrossRefPubMedPubMedCentral Cuneo A, Follows G, Rigolin GM, et al. Efficacy of bendamustine and rituximab as first salvage treatment in chronic lymphocytic leukemia and indirect comparison with ibrutinib: a GIMEMA, ERIC and UK CLL FORUM study. Haematologica. 2018;103(7):1209–17.CrossRefPubMedPubMedCentral
19.
go back to reference Sood A, Parihar A, Lad D, Basher R, Singh H, Mittal B. An unusual presentation of Richter's transformation of chronic lymphocytic leukemia in liver and lung on 18 F-labeled fluoro-2-deoxyglucose positron emission tomography/computed tomography Interesting Image. Indian J Nucl Med. 2020;35(1):70–1. Sood A, Parihar A, Lad D, Basher R, Singh H, Mittal B. An unusual presentation of Richter's transformation of chronic lymphocytic leukemia in liver and lung on 18 F-labeled fluoro-2-deoxyglucose positron emission tomography/computed tomography Interesting Image. Indian J Nucl Med. 2020;35(1):70–1.
20.
go back to reference Lad DP, Varma S, Varma N, et al. Short response duration to initial treatment of autoimmune cytopenias in chronic lymphocytic leukemia. Blood. 2014;124(21):2.CrossRef Lad DP, Varma S, Varma N, et al. Short response duration to initial treatment of autoimmune cytopenias in chronic lymphocytic leukemia. Blood. 2014;124(21):2.CrossRef
21.
go back to reference Chopra M, Jain A, Chhabra S, et al. Short research communication anti-spike antibody response to COVISHIELD (SII-ChAdOx1 nCoV-19) vaccine in patients with B-cell and plasma cell malignancies and hematopoietic cell transplantation recipients. Indian J Hematol Blood Transfus. 2022;38(4):745–9. Chopra M, Jain A, Chhabra S, et al. Short research communication anti-spike antibody response to COVISHIELD (SII-ChAdOx1 nCoV-19) vaccine in patients with B-cell and plasma cell malignancies and hematopoietic cell transplantation recipients. Indian J Hematol Blood Transfus. 2022;38(4):745–9.
22.
go back to reference Lad D, Malhotra P, Varma N, et al. CLL: common leukemia; uncommon presentations. Indian J Hematol Blood Transfusion. 2016;32(3):268–75.CrossRef Lad D, Malhotra P, Varma N, et al. CLL: common leukemia; uncommon presentations. Indian J Hematol Blood Transfusion. 2016;32(3):268–75.CrossRef
25.
go back to reference Karulkar A, Jain H, Shah S, et al. Making anti-CD19 CAR-T cell therapy accessible and affordable: first-in-human phase I clinical trial experience from India. Blood. 2022;140(Supplement 1):4610–1.CrossRef Karulkar A, Jain H, Shah S, et al. Making anti-CD19 CAR-T cell therapy accessible and affordable: first-in-human phase I clinical trial experience from India. Blood. 2022;140(Supplement 1):4610–1.CrossRef
26.
go back to reference Sathyanarayanan V, Flowers CR, Iyer SP. Comparison of access to novel drugs for lymphoma and chronic lymphocytic leukemia between India and the United States. JCO Global Oncol. 2020;6:1124–33.CrossRef Sathyanarayanan V, Flowers CR, Iyer SP. Comparison of access to novel drugs for lymphoma and chronic lymphocytic leukemia between India and the United States. JCO Global Oncol. 2020;6:1124–33.CrossRef
27.
go back to reference Kater AP, Lanasa MC, Wesselmann J, Fischer K. The 8th young investigators’ meeting on chronic lymphocytic leukemia. Leuk Lymphoma. 2015;56(5):1556–9.CrossRef Kater AP, Lanasa MC, Wesselmann J, Fischer K. The 8th young investigators’ meeting on chronic lymphocytic leukemia. Leuk Lymphoma. 2015;56(5):1556–9.CrossRef
Metadata
Title
How Do We Manage Chronic Lymphocytic Leukemia in India
Authors
Parathan Karunakaran
Nidhi Jain
Deepesh P. Lad
Publication date
01-02-2024
Publisher
Springer US
Published in
Current Hematologic Malignancy Reports / Issue 2/2024
Print ISSN: 1558-8211
Electronic ISSN: 1558-822X
DOI
https://doi.org/10.1007/s11899-023-00722-7

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