Ibrutinib in combination with bendamustine and rituximab improves quality of life factors in patients with severe impairment

This study examined how treatment with ibrutinib (Imbruvica), rituximab (Rituxan), and bendamustine (Treanda) impacts quality of life in chronic lymphocytic leukemia (CLL) patients. Factors such as fatigue, physical functioning, and well-being were all improved among those patients with the lowest scores before treatment.

CLL is cancer of the blood and bone marrow. It is one of the most common types of leukemia in adults. The average age at diagnosis is 72 years. Many CLL patients show good response to treatment. Since patients may live with their disease for many years, it is important to maintain a good quality of life. Commonly reported symptoms of CLL are fatigue and poor physical functioning.

Standard first-line treatment for CLL is tyrosine kinase inhibitor therapy, such as ibrutinib. Patients with relapsed (return of the disease) CLL may receive ibrutinib in combination with the monoclonal antibody therapy (a specific type of protein) rituximab and the chemotherapy bendamustine. The effects of these modern treatment approaches on health-related quality of life need to be better understood.

578 patients with relapsed CLL were randomly assigned to treatment groups. 289 patients received ibrutinib with rituximab and bendamustine. 289 patients received rituximab and bendamustine with a placebo (control drug with no active effect). Questionnaires measured symptoms and quality of life before, during, and at the end of treatment.

No significant changes were observed in both treatment groups in the overall scores on fatigue, well-being, and quality of life. However, further analysis showed that those patients who were the most fatigued before treatment showed significant improvements in fatigue with treatment. This improvement was greater in patients receiving ibrutinib. The same applied to physical functioning. Patients with the greatest impairment in physical functioning showed the largest improvements. This was more pronounced in patients receiving ibrutinib.

90 patients had reported of feeling ill ‘quite a bit’ or ‘very much’ before treatment. Of these, 20 to 30% achieved a return to well-being within the first cycle of treatment. This increased to around 50% by treatment cycle 8 for patients receiving ibrutinib. It stayed at around 30% for patients receiving rituximab and bendamustine without ibrutinib.

This study concluded that ibrutinib with rituximab and bendamustine improves fatigue, physical functioning, and well-being in CLL patients who had the greatest room for improvement.

The group of patients with the worst fatigue or physical impairment was quite small. Larger studies are needed to confirm these findings.