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Obinutuzumab Dosing in CLL: Wider Clinical Implications of Practices in Manitoba?

By: Celeste L. Dixon
Posted: Tuesday, May 10, 2022

Real-world treatment approaches for chronic lymphocytic leukemia (CLL) continue to be fine-tuned. According to Versha Banerji, MD, of Max Rady College of Medicine in Winnipeg, Manitoba, Canada, and colleagues, for instance, when the obinutuzumab/chlorambucil regimen is selected, first-dose infusion reactions with obinutuzumab may be notably reduced via two strategies: by using chlorambucil to decrease a patient’s lymphocyte count before obinutuzumab is given, and by using a relatively slow initial infusion rate for obinutuzumab. The investigators described their findings in BMC Cancer.

Local Manitoba practice, explained the team, is to infuse obinutuzumab at a slower rate than the rate at which it was infused in the phase III, randomized CLL11 study. Additionally, Manitoba practitioners routinely use chlorambucil prior to beginning obinutuzumab treatment. The slower infusion rate means obinutuzumab “must be given over a longer duration, which increases the costs, such as nursing time, associated with delivering the infusion,” wrote Dr. Banerji and co-investigators. However, the slower rate “likely lowers the severity of infusion-related reactions, which reduces costs associated with managing [those] reactions.”

In the retrospective chart review of the 67 CancerCare Manitoba patients with CLL who were treated with obinutuzumab and chlorambucil between 2014 and 2017, the researchers found that the rate of grade 3 or 4 obinutuzumab infusion–related reactions was 6%, compared with the 20% rate in the CLL11 trial.

Of the 67 study patients, 29 were older than 75. Although the rate of reactions was higher in those aged 75 and older versus in those aged 75 and younger, the difference was not statistically significant. Nor was there a significant difference in reaction rate between patients whose Cumulative Illness Rating Scale scores were below 8 versus 8 or higher. “Older [and frail] patients with comorbidities can be treated with obinutuzumab/chlorambucil safely and with good outcomes in a non-trial environment,” concluded the researchers.

Disclosure: The study authors reported no conflicts of interest.


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