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ASH 2021 | Clinical and economic impact of Tumor Lysis Syndrome in patients with CLL or SLL

Kerry Rogers, MD, The Ohio State University, Columbus, OH, discusses a recent study looking at the economic burden of tumor lysis syndrome (TLS) in patients with chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL). Several therapies used for the treatment of these patients can increase the risk of patients developing TLS, including obinutuzumab, chemoimmunotherapy, and venetoclax. There is already a strategy in place to help reduce the risk of developing TLS with venetoclax. The study looked for patients who developed TLS within 90 days of starting one of these therapies, and found that there was a higher cost of caring for these patients, due to the increase in in-patient treatment. This interview took place at the 63rd ASH Annual Meeting and Exposition congress in Atlanta, GA.

Transcript (edited for clarity)

There’s a really neat collaboration that is with Janssen. And we looked at the economic burden of tumor lysis syndrome. So this was something using claims data, so I was very excited to collaborate with them on this type of project. So for anyone who doesn’t know, tumor lysis syndrome occurs when you have so much breakdown of cancer cells, that it releases uric acid, electrolytes, and other toxins into the blood...

There’s a really neat collaboration that is with Janssen. And we looked at the economic burden of tumor lysis syndrome. So this was something using claims data, so I was very excited to collaborate with them on this type of project. So for anyone who doesn’t know, tumor lysis syndrome occurs when you have so much breakdown of cancer cells, that it releases uric acid, electrolytes, and other toxins into the blood. It can result in hospitalization, need for dialysis, and death if left untreated. CLL has a pretty high risk of tumor lysis syndrome with several drugs. So this study actually goes back quite a ways and looks at treatments that are in the guidelines at high risk for tumor lysis syndrome. So this includes obinituzumab, chemoimmunotherapies, and venetoclax.
So what the study was, was looking at patients who developed tumor lysis syndrome within 90 days of starting one of these therapies that’s in the guidelines of having high risk for tumor lysis syndrome. And then it’s kind of divided into 30-day segments. And so segments in patients that never develop tumor lysis syndrome are considered non-TLS segments. And then if someone develops tumor lysis syndrome, 30-day segments before that are considered non-tumor Lysis, and after that are considered tumor lysis kind of ongoing, which was, the most feasible way to look at this, but you do have patients that could contribute to both TLS and non-TLS kind of segments or data. We found that, unsurprisingly, the cost of taking care of patients who did develop tumor lysis syndrome was more. So it was more expensive per month to take care of people that had tumor lysis syndrome. And that was mostly driven by inpatient cost because people are hospitalized for this. So while this isn’t a surprising finding, I think it is really important to realize what a burden tumor lysis syndrome has on the health care system.
We did also look at venetoclax, which has a very important and strict tumor lysis syndrome mitigation strategy, including slow dose ramp-up and monitoring scheme, and found that that was more costly at initiation than some of the other therapies, but the cost of tumor lysis syndrome, if people developed it was more. So this is probably a very worthwhile strategy to do anything, to mitigate that risk, even if there is some economic burden to that, just because developing tumor lysis syndrome from an economic burden standpoint, that’s really a high burden.
Also people who develop tumor lysis syndrome are more likely to switch therapies in the near term. And I think that’s important, too. So really kind of the results were what we expected to see, but it’s important to confirm that using real-world datasets in this manner. And also, I think this kind of adds to what physicians need to think about when choosing a regimen that has a risk of tumor lysis syndrome. And also that this is something that they need to discuss with their patients. So it was a really fun collaboration with Janssen that I enjoyed working on with them.

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