Research

VA Patients Lack Testing to Optimize CLL Treatment

by U.S. Medicine

April 14, 2018

SALT LAKE CITY — The presence of deletion 17p (del17), determined by chromosome analysis and/or fluorescence in situ hybridization (FISH), is a strong negative prognostic marker in chronic lymphocytic leukemia (CLL), according to a report in the Journal of Clinical Oncology.1

Prior to the introduction of novel agents such as ibrutinib and venetoclax, the clinical utility of cytogenetics/FISH was limited by the absence of chemoimmunotherapy regimens that were proven effective in patients with del17.

A study team led by Salt Lake City VAMC researchers noted that testing practices for chromosomal aberrations since the introduction of novel agents have not been reported and focused on cytogenetic/FISH trends in a nationwide cohort of veterans diagnosed with CLL.

The VA Clinical Cancer Registry was used to identify CLL patients diagnosed 2008-2015 and receiving care at VA. At the same time, electronic medical records were used to determine cytogenetic/FISH testing (lab records), treatment histories (pharmacy dispensation records), and evidence of system use (heme-onc notes).

Cytogenetic/FISH testing was identified by presence of specific keywords in the test name or Logical Observation Identifiers Names and Codes (LOINC) descriptions, then validated by human annotation. The testing rates were reported for the entire cohort, at time of diagnosis, time of regimen initiation (including the 12 months preceding initiation), during the novel era (2014-2015) and prior (2008-2013), the authors noted.

Results indicated that, from 2008 to 2015, 3,638 CLL patients were diagnosed and received care at VA. Documented records of treatment regimens were available for 1,562 patients who received a total of 2,929 treatment regimens. Yet, only 24% (998) of patients were tested at any point in time during their care at the VA, 17% (622) were tested at time of diagnosis, and 19% (542) of treatment courses were preceded by cytogenetic/FISH testing.

The study group found No testing differences existed following the introduction of the novel agents at diagnosis (both ˜ 17%) or prior to regimen initiation (20% vs. 16%).

“Our study suggests CLL patients diagnosed and receiving care at the VA are not routinely undergoing cytogenetics/FISH testing at diagnosis or prior to treatment,” researchers explained. “Changing this practice pattern will personalize treatments so that del17 CLL patients receive less toxic and more effective therapies.”


1Halwani AS, Burningham Z, Rasmussen KM, Patil V, et. Al. Cytogenetic and fluorescence in situ hybridization testing in veterans with chronic lymphocytic leukemia. Journal of Clinical Oncology 35, No. 15_suppl (May 2017) 7526-7526. DOI: 10.1200/JCO.2017.35.15_suppl.7526.


Comments are closed here.


Related Articles

Effective Metrics Help VA Exceed National Goal for Colorectal Cancer Screening

More Than 80% of Patients Meet Recommendations LOS ANGELES—More than four out of five veterans eligible for colorectal cancer screening have been screened, putting the largest healthcare system in the United States among the top... View Article

More Options, Better Survival for Veterans With Metastatic Pancreatic Cancer

ALBANY, NY—Pancreatic cancer remains one of the deadliest malignancies in the United States, but new therapies can extend life and improve quality of life for many patients. That is especially the case at the VA,... View Article


U.S. Medicine Recommends


More From research

Research

Genetic Mutations Affecting Response to Drugs Are Common in Veterans

VA Debates Who Should Receive Pharmacogenetic Testing SALT LAKE CITY—A massive VA study revealed that 99% of veterans have at least one genetic mutation known to affect response to specific drugs, including some commonly prescribed... View Article

Research

VA Researcher Seeks to Include Veterans’ Voices in Healthcare Decisions

SEATTLE—It’s a big job to ensure that VA’s healthcare system is equipped to provide the best possible care to veterans. It might be an even bigger job to make sure that veterans across the country... View Article

Research

First-Ever Study Focuses on How Well VHA Cares for TIA Patients

INDIANAPOLIS — While many healthcare systems measure the quality of their stroke care, looking at performance early in the vascular disease process can help avoid acute events altogether.

Research

Link Between Pain, Brain Disruption in Gulf War Veterans

MADISON, WI — Chronic musculoskeletal pain (CMP) affects about one-fourth of the 700,000 veterans deployed during the Persian Gulf War in 1990-1991. A study in the journal Pain pointed out that the cause of their... View Article

Research

Early Relapse After AHCT Bad Sign in Multiple Myeloma

ROCHESTER, MN — Duration of initial disease response remains a strong prognostic factor in multiple myeloma (MM), especially for upfront autologous hematopoietic cell transplant (AHCT) recipients. A study in the journal Leukemia hypothesized that new... View Article

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up