b'Targeted Therapies for CLL WidelyUsed at VA; Prolonged SurvivalMore than 13,000 U.S. veterans treated in the VHA have a diagnosis of chronic lymphocytic leukemia, which is associated with toxic military exposures.For the past 20 years, the VA has routinely treated patients with CLLdiagnosis in accordance with clinical guidelines. Those who received recommended targeted therapies had longer overall survival.By LaTina EmersonLONG BEACH, CAU.S. military veterans withdiagnosis, but not with a worse overall survival.chronic lymphocytic leukemia (CLL) routinely re- The study used VAHS medical records and exam-ceived therapies in line with current evidence-basedineddatafrompredominantlyadultmalepatients treatment practices over the past two decades, anddiagnosedwithchroniclymphocyticleukemia those who were treated with targeted therapies hadthat was managed in the VHA from January 1999 longer overall survival, according to a national VAthrough December 2020. The final analysis included study with more than 20 years of clinical data.16,331 patients with CLL. First-line and subsequent TheretrospectiveanalysispublishedinClinicaltreatmentpatternswereretrospectivelytrended Lymphoma Myeloma and Leukemia described treat- over 20 years, and factors associated with survival ment patterns in the VA system over time and ana- were studied in both untreated and treated patients, lyzed outcomes in U.S. military veterans diagnosedaccording to the authors. withchroniclymphocyticleukemia.ThestudyWe found that, in the national VA health care sys-authors were affiliated with the VA Long Beach, CA,tem,U.S.militaryveteranswithchroniclympho-Healthcare System. 1 cytic leukemia received therapies in line with current The authors sought to explore this topic, becauseevidence-based treatment practices over the past 20 military exposures such as Agent Orange are asso- years, Ma said. Treatment with targeted therapies is ciated with the development of chronic lymphocyticassociated with longer median overall survival both in leukemiaandlymphomas,HelenMa,MD,staffthe first line and relapsed/refractory setting.physicianattheVAlongBeachfacility,toldtheOverall,theanalysisconcludedthatprescribing Compendium of Federal Medicine. patterns in the VA indicated that patients are receiving Chroniclymphocyticleukemia/smalllymphocyticstandard of care drugs in a timely manner. lymphoma (CLL/SLL) is the most common adult leu- The authors pointed out that exposure to targeted kemia in Western countries. More than 13,000 veter- therapies as either first line or in subsequent lines of ans have the diagnosis.therapy was associated with longer survival, resulting Patients can live with the disease for many yearsin median overall survival of 8.5 years (95% confi-and may eventually need treatment, said Ma, whodence interval (CI), 8.0-9.1) compared to 3.5 years also is a health sciences assistant clinical professor at(95% CI, 3.5-3.9) in patients who never received tar-the University of California, Irvine, in Orange, CA.geted therapy ( P .0001). Veterans may have increased risk factors, e.g., expo- The study also found that targeted therapies given sures and age that predispose them to the diagnosis ofto patients who are not candidates for intensive che-chronic lymphocytic leukemia. moimmunotherapymaycounteractpoorprognostic Thestudyauthorsnotedthatexposureto Agentfactors, such as older age.OrangemaybeassociatedwithayoungerageatConversely, the analysis found that patients who 77'