February 2012 Vol 5, No 1, Special Issue

Few analyses to date have as­sessed the long-term costs associated with the management of chronic myeloid leukemia (CML). At ASH 2011, Shrividya Iyer, PhD, of Pfizer, presented results of a retrospective analysis performed by a group of researchers at Pfizer and the Eliassen Group that looked at information from the Thomson Reuters MarketScan Commercial Claims and Encounters Database, and the Medicare Supple­mental Database. Medical claims for the years 2002-2009 were used for 2583 patients with CML who had ≥2 claims associated with a CML diagnosis.

Instituting guidelines-based test ordering could lead to more effective, accurate, and complete diagnosis and monitoring of hemato­lymphoid malignancies, while reduc­ing costs, according to hematopatho­lo­gists at Vanderbilt Univer­sity Medical Center, Nashville, who said that tests were frequently overordered by their hematologists.

Preliminary data from the phase 2 PACE (Ponatinib Ph+ALL and CML Evaluation) trial show that ponatinib (Ariad Pharmaceuticals) can overcome the difficult-to-treat T315I mutation in patients with chronic myeloid leukemia (CML). Currently, patients with this genetic mutation have no effective treatment options.

In PACE, the tyrosine kinase inhibitor (TKI) ponatinib achieved a 47% major cytogenetic response (MCyR). For patients with the T315I mutation, ponatinib induced a 65% MCyR. This drug was specifically designed to overcome the T315I mutation.

The first-generation proteasome inhibitor bortezomib changed the treatment paradigm of multiple myeloma. Data are now maturing for the next-generation agent carfilzomib, with US Food and Drug Administration approval expected soon. Several novel agents in this class are also in the pipeline. These second-generation agents appear to be as effective as bortezomib but less neurotoxic, according to studies presented at ASH 2011.

Venous thromboembolism (VTE) is a common cause of serious morbidity and mortality, and patients with cancer are at particular risk. “VTE has a substantial burden on the current US medical system. Its preventable costs and indirect costs from premature deaths are substantial,” said Alex C. Spyropoulos, MD, of McMaster University, Hamilton, Canada.

Accountable care organizations (ACOs) are the new model of care that has generated a buzz in the industry, but their role in hematology and oncology practices remains unclear. “They’re like unicorns,” said Lawrence A. Solberg, Jr, MD, PhD, of the Mayo Clinic, Jacksonville, FL. “We have an idea of what they’re supposed to look like, we’ve read about them, but I’ve yet to meet a hematologist who’s actually seen one.”

A large, ongoing Canadian study provides an overview of the cost of managing non-Hodgkin lymphoma (NHL). “Our study provides total and stage-specific cost estimates for NHL, where attributable costs were 3- to 7-fold higher than those for non-NHL controls, and increased by stage,” said Pierre K. Isogai, BSc, of Sunnybrook Health Sciences Centre in Toronto.

Patients with early-stage nonbulky classic Hodgkin lymphoma (HL) receive intensive radiologic surveillance after treatment, despite a low risk for relapse. A study from Memorial Sloan-Kettering Cancer Center (MSKCC) concluded that routine imaging is unnecessary.

The study evaluated the risk for relapse and value of imaging in a subset of patients who achieved complete remission (by positron-emission tomography [PET]) after 6 cycles of standard chemotherapy with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine).

Graft-versus-host disease (GVHD) remains a common complication of hematopoietic stem-cell transplant, but little is known about the rate of hospital admissions and the associated costs. Fiona L. Dignan, MD, of the Royal Marsden Hospital, United Kingdom, presented a study comparing readmission rates and associated costs between patients with GVHD and controls.

The analysis included all patients undergoing allogeneic stem-cell transplant (two thirds for leukemia) at the hospital between 2006 and 2009, and followed for a median of 3.2 years.

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