Chemotherapy-free approach looks optimistic for older Chronic Lymphocytic Leukaemia patients

Professor Stephen Opat

An international clinical trial for Chronic Lymphocytic Leukaemia (CLL), including collaborators at Monash University, has examined a ‘chemotherapy-free’ drug combination in older patients for the first time.

Monash Health and Monash University researchers were the major Australian contributors to the international study, the results of which were published last week in Blood.

Director of Monash Haematology Professor Stephen Opat said it was the first time that a combination of two highly effective alternatives to chemotherapy were analysed in typical older patients with CLL who have other health concerns.

“Patients were given an antibody (obinutuzumab) directed against lymphoma cells and a drug (Venetoclax) that was developed here in Melbourne at the Walter and Eliza Hall Institute of Medical Research,” said study co-author Professor Opat.

 “The study showed the two therapies could be combined fairly safely and that at the end of the treatment (using a very sensitive molecular test), 11 out of 12 assessable patients had no evidence of disease in the bloodstream.”

The paper is a first look at the combination therapy, although the full study results won’t be available for many months.

“This study is very important because while CLL is very treatable, only a minority of patients would achieve this level or disease eradication—and they are usually younger patients receiving more aggressive chemotherapy,” said Professor Opat.

“Elimination of low levels of CLL has been associated with longer periods of disease control with some patients never needing to be retreated.”

CLL is the most common leukaemia adults, with a lifetime risk of 0.5-1%.

Clinical trials provide financial reward to hospitals and cutting edge treatments

Clinical trials patient Mr Sin 

Monash Haematology researchers have demonstrated that clinical trials not only benefit patients but provide a significant financial boost to the hospital system as well.

The Haematology Research Unit at Monash Health provides treatment and follow up care for nearly 400 patients every year, many participating in clinical trials.

“We treat a wide variety of blood cancer and non-cancer haematology patients, including chronic lymphocytic leukaemia, follicular lymphoma, B cell lymphoma, myelodysplastic syndrome, Waldenstrom’s macroglobulinaemia, chronic and acute myeloid leukemia, T cell lymphoma and more,” said Head of the Department of Haematology Professor Stephen Opat.

A recent report by the Haematology Research Unit shows that providing clinical trials to patients has a positive effect on Monash Health’s bottom line, as well as offering cutting-edge treatments that may not otherwise be available.

Mr Sin with Clinical Trials Coordinator Ms Liz Coughlin

Monash Haematology patient Mr Yoeun Sin has Waldenstrom Macroblobulinemia, a type of non-Hodgkin lymphoma. Mr Sin is the first patient in the world to receive an experimental drug (BGB3111) to treat the disease.

Professor Opat said Mr Sin is a typical Monash patient whose previous two treatments had failed,  and thanks to the clinical trial, his experimental treatment had been life changing.

“I feel very honoured and grateful for being the first person to receive BGB3111—without this drug I’m not too sure where or how I’d be in terms of health,” said Mr Sin.

Mr Sin said the opportunity to take part in the clinical trial has given him another chance at life.

“I now feel full of life and filled with energy. Taking BGB3111 has given me the opportunity to do more with the amount of time I have left...which I hope is a long time,” he said. 

Professor Opat said the Haematology Research Unit operates on a self-funded model, supporting the wages of all staff and covering all treatment and follow-up care related costs of patients.

“The patients treated or managed in our unit are in effect, taken out of the Monash Health care network in relation to the costs that would normally be associated with their treatment and care,” said Professor Opat.

In order to demonstrate their savings, the Haematology Research Unit selected 25 patients who were treated and commenced follow up for various haematological malignancies in the 2015-2016 financial year, and calculated the costs that would have been associated with these patients had they received standard of care treatment through the public health system at Monash Health.

Professor Opat said that by treating, and providing follow up care for this selection of 25 patients, the Haematology Research Unit relieved the Health care network of $843,363.80 of funding that would be required to care for these patients over their treatment and standard 5 year follow up periods.

“$759,333 of this cost is relieved in the first year while patients are having treatment, and $713,862 being pharmacy related costs.” 

“Our Unit in fact treated and provided follow up care for 86 patients with haematological malignancies in the 2015-2016 financial year, so we estimate the financial relief to Monash Health for the treatment period alone, could be as high as $2,612,105,” said Professor Opat.

These figures don’t take into account the further financial benefit due to the treatment, management and care of the 254 non-oncology haematology patients during the same period.

Professor Opat said he is exceptionally proud of the work that his Unit continues to do, the quality with which we do it, and the savings that we continue to make toward the health care network.

Haematology Clinical Trial Unit Managers Ms Micheleine Uhe and Ms Jeanette Gamgee attribute the success of the Unit to the dedication of their extremely efficient and hard-working team.