Findings of a recent study suggest that costs may be quite substantial when it comes to patients with relapsed Philadelphia chromosome (Ph)-negative B-cell acute lymphoblastic leukemia (ALL). Investigators reported at the 2017 American Society of Hematology Annual Meeting (ASH 2017) that infections, cytopenia, and GI toxicity events affect the vast majority of patients with relapsed Ph-negative ALL. The economic burden associated with adverse events of special interest (AESI) is substantial, with infections being the most expensive AESI, followed by cytopenia and GI toxicity.

The researchers defined AESI as infections (including bacteremia, febrile neutropenia, line infections, pneumonia, and sepsis), cytopenia (including anemia, neutropenia, thrombocytopenia, and other cytopenia), or GI toxicities (including nausea/vomiting, diarrhea, gastritis/duodenitis, GI bleeding, and mucositis/stomatitis).

This patient population often is extremely ill and further compromised by treatment. Treatment-related complications are common and often managed with inpatient admission. Researchers investigated the rates and economic burden of infections, cytopenia, and GI toxicity events among adults with relapsed Ph-negative ALL.

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The team conducted a retrospective cohort study using Truven Health MarketScan® Commercial and Medicare Supplemental Databases. Patient data was extracted during April 1, 2009, through October 31, 2016. All patients were required to have had 1 or more hospitalizations on or after the first relapsed ALL diagnosis.

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For this investigation, the researchers followed patients until the earliest event of inpatient death, end of continuous enrollment, end of the study period (October 31, 2016), or 100 days post index. The team examined the proportion of patients with AESI and AESI-related healthcare costs for any AESI.  They also examined specific AESI categories and events.

The researchers identified 400 patients with relapsed Ph-negative ALL who experienced at least 1 AESI during a mean follow-up period of 84 days. Among these 400 patients, 92.5% of them were male, mean age was 41.9 years and 63% had a mean Charlson comorbidity index of 3.0. 

The researchers found that 64.6% had infections, 94.6% had cytopenia, and 46.2% had GI toxicity events. The most frequent infection was sepsis (40%). The most frequent cytopenic events were neutropenia (68.4%) and anemia (63%). The most frequent GI toxicity event was nausea/vomiting (26.8%).

The total average AESI-related healthcare costs during 100 days post index date was $197,213.  The researchers found that the mean number of AESI-related hospitalizations was 2.0, with a total mean length of stay of 32.2 days during the follow-up.  The study also demonstrated that the mean healthcare costs were highest for infection-related events ($164,461), followed by cytopenia ($125,210) and GI toxicity-related events ($11,652).

The team discovered that at the specific event level, average healthcare costs were highest for sepsis ($204,151) and other cytopenia-related events ($98,900).  The authors concluded that new therapies are urgently needed to help improve the outcomes of patients with relapsed Ph-negative ALL.


Zhang X, Song X, Lopez-Gonzalez L, Jariwala-Parikh K, Romanov V, Cong Z. Economic burden associated with adverse events of special interest (AESI) in patients with relapsed acute lymphoblastic leukemia (ALL) in the US.  Poster presentation at: 2017 American Society of Hematology Annual Meeting; December 9-12, 2017; Atlanta, GA. Abstract 4683.

This article originally appeared on ONA