LONG BEACH, CA — Chronic lymphocytic leukemia and small lymphocytic lymphoma (CLL/SLL) are the most common forms of adult leukemia. More than 13,000 veterans have the diagnosis, which is associated with the toxic exposures included in the Pact Act, according to the VA.
U.S. veterans who are treated within the VA Healthcare System are managed in a national single-payer system with access to Food and Drug Administration-approved therapies.
A recent study in Clinical Lymphoma, Myeloma & Leukemia described prescribing patterns and outcomes of patients with CLL managed in the VA system.
Researchers from the VA Long Beach, CA, Healthcare System and the University of California Irvine in Orange, CA, conducted a retrospective analysis of adult patients diagnosed with CLL managed in the VA from January 1999 through December 2020.
With first-line treatment patterns trended over 20 years., the study team analyzed factors associated with survival in both untreated and treated patients. In the final analysis, the included 16,331 patients with CLL.
Results indicated that the median overall survival (OS) for the whole cohort was 8.7 years (95% confidence interval [CI], 8.6-8.9). The median OS from diagnosis was 8.9 years (95% CI, 8.6-9.2 in untreated patients with CLL. In treated patients, the median time to first-line treatment was 1.9 years (range, 0-21 years), and the median OS from initiation of treatment was 5.0 years (95% CI, 4.8-5.2).
“First-line treatments varied over time, consistent with FDA approval of targeted therapies,” the researchers pointed out. “Exposure to targeted therapies as either first line or in subsequent lines of therapy was associated with longer survival: median OS of 8.5 years (95% CI, 8.0-9.1) compared to 3.5 years (95% CI, 3.5-3.9) in patients who never received targeted therapy (P < .0001).”
The article concluded that patients treated in the VA “have received therapies in line with current evidence-based treatment practices over the past 20 years. Treatment with targeted therapies is associated with longer median OS both in the first line and relapsed/refractory setting.”
The number of servicemembers diagnosed with leukemia is expected to increase. In what could be the first conditions added to the new PACT Act, the VA is conducting a scientific review to determine any relationship between three conditions—acute leukemias, chronic leukemias, and multiple myeloma outside of the head and neck—and toxic exposures for servicemembers who deployed to Iraq, Afghanistan, Somalia, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, Uzbekistan, and the entire Southwest Asia theater of operations.
This scientific review will help VA determine whether these conditions become presumptive conditions for veterans. When a condition is considered presumptive, VA automatically assumes service connection for the disease and provides benefits accordingly. That means that eligible veterans do not need to prove that their service caused their disease to receive benefits for it.
The Biden administration has made it clear that it wants to expand benefits and services for toxic-exposed veterans and their families. For the first time, VA will use a new process for establishing presumptive conditions as codified by the PACT Act, which expanded VA healthcare and benefits for veterans exposed to burn pits, Agent Orange and other toxic substances.
The process considers all available science and data—including veteran claims data—to establish new presumptive conditions, when appropriate, for veterans as quickly as possible. It is not as reliant as in the past on research outside the VA.
Cancers of the head and neck are already considered presumptive under the PACT Act, so this research will focus solely on acute leukemias, chronic leukemias and multiple myeloma originating outside of the head and neck.
The VA said those conditions were chosen for scientific review based on existing scientific data and close consultations with veterans, veteran service organizations, Congress and other key stakeholders.
- Ma H, O’Brien S, Gupta P. Treatment Patterns and Outcomes in U.S. Military Veterans Diagnosed With Chronic Lymphocytic Leukemia (CLL). Clin Lymphoma Myeloma Leuk. 2023 Sep 7:S2152-2650(23)01548-3. doi: 10.1016/j.clml.2023.09.001. Epub ahead of print. PMID: 37743181.