Comorbidities at Diagnosis, Survival, and Cause of Death in Patients with Chronic Lymphocytic Leukemia: A Population-Based Study

Villavicencio, Alicia; Solans, Marta; Zacarías-Pons, Lluís; Vidal, Anna Paré; Puigdemont, Montse; Roncero, Josep María; Sáez, Marc; Marcos‐Gragera, Rafael

doi:10.3390/ijerph18020701

Cited by 8 publications

(9 citation statements)

References 35 publications

(37 reference statements)

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“…Nevertheless, in a recent cohort, CLL-related and unrelated mortalities were not associated with CCI score at multivariate analysis. 24 More clear is the independent prognostic role exerted by comorbidities on chemotherapy-based treatment outcome. 25-28 …”

Section: Discussionmentioning

confidence: 99%

Do age, fitness, and concomitant medications influence management and outcomes of patients with CLL treated with ibrutinib?

et al. 2021

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Functional reserve of organs and systems is known to be relevant in predicting immunochemotherapy tolerance. Age and comorbidities, assessed by the cumulative illness rating scale (CIRS), have been used to address chemotherapy intensity. In ibrutinib era it is still unclear whether age, CIRS and ECOG-PS retain their predictive role on treatment vulnerability. In this 712 CLL patients series treated with ibrutinib outside clinical trials, baseline ECOG-PS and neutropenia, resulted as the most accurate predictors of treatment feasibility and outcomes. Age did not independently influence survival and ibrutinib tolerance, indicating that not age per se, but age-related conditions may affect drug management. We confirmed the role of CIRS>6 as a predictor of a poorer progression and event-free survival (PFS, EFS). The presence of a severe comorbidity was significantly associated with permanent dose reductions (PDR), not translating into worse outcomes. As expected, del(17p) and/or TP53mut and previous therapies affected PFS, EFS and overall survival. No study so far has analyzed the influence of concomitant medications and CYP3A-inhibitors with ibrutinib. In our series, these factors had no impact, though CYP3A4 inhibitors use correlated at Cox regression analysis, with an increased risk of PDR. Despite the limitation of its retrospective nature, this large study confirmed the role of ECOG-PS as the most accurate predictor of ibrutinib feasibility and outcomes and importantly neutropenia emerged as a relevant tool influencing patients vulnerability. Although CIRS>6 retained a significant impact on PFS and EFS its value should be confirmed by prospective studies.

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Section: Discussionmentioning

confidence: 99%

Do age, fitness, and concomitant medications influence management and outcomes of patients with CLL treated with ibrutinib?

et al. 2021

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“…Segundo Villavicencio et al, (2021), em uma coorte de 2008 e 2016, localizada no nordeste da Espanha, cerca de 400 pacientes foram analisados, tendo taxa de prevalência para LLC, com mediana etária ao diagnóstico de 72 anos possuindo intervalo interquartil entre 60-80 anos. Cerca de 57,5% da população eram do sexo masculino, de raça branca e apresentava LLC em estágio inicial (estádio Rai 0) no momento do diagnóstico, sendo que 1,25% desses pacientes evoluíram para linfoma agressivo (síndrome de Richter).…”

Section: Resultsunclassified

Prevalência e Diagnóstico de pacientes com Leucemia Linfocítica Crônica no Extremo Sul da Bahia, Bahia, Brasil

Ribeiro

Alves²,

Petinari³

2023

RSD

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A Leucemia Linfocítica Crônica (LLC) constitui-se como uma neoplasia proliferativa das células B, promovendo aumento do baço, fígado e linfonodos, acometendo principalmente indivíduos do sexo masculino, raça branca e com alta incidência a partir dos 65 anos de idade. O diagnóstico consiste na realização de exames como hemograma, mielograma, detecção de marcadores celulares agrupadores de diferenciação (CDs). Assim, objetivou-se identificar a prevalência de pacientes com LLC no Extremo Sul da Bahia, analisando os marcadores dos protocolos de diagnóstico laboratoriais. O presente estudo é um coorte retrospectivo de 2015 a 2019, sob Aprovação CAAE: 5.336.684 do CEP/CONEP, de prontuários de pacientes com LLC realizado na Unidade de Alta Complexidade em Oncologia – UNACON, situado no município de Teixeira de Freitas, Bahia. Dessa forma, os resultados permitiram constatar que, conforme informações do DATASUS, dos 82 casos diagnosticados de doenças linfoproliferativas crônicas, entre 2015 a 2019 do Extremo Sul da Bahia, seis casos eram de LLC. Nos prontuários haviam características clínico-epidemiológicas, 66,7% eram em pacientes homens; com 50% de indivíduos brancos e pardos, apresentando linfocitose, plaquetopenia e anemia normocítica-normocrômica (50%), um caso (16,7%) portando Manchas de Gumprecht e um caso (16,7%) apresentando CD79 e IGV15. Quanto às conclusões, viu-se que os marcadores de diagnóstico mais utilizados compreenderam a realização de exames hematológicos como hemograma e mielograma, incluindo características hematológicas/bioquímicas, em especial a linfocitose, leucocitose, plaquetopenia, anemia, com destaque para as características imunofenotípicas, por CDs 19 e 79, sendo a prevalência baixa no Extremo Sul da Bahia de apenas 7,3% de casos diagnosticados com LLC.

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“…Variables included in multivariate Cox regression included age and Charlson-Deyo comorbidity score, and were selected for their established association with worse survival outcomes in CLL. (25,26) To assess how survival between racial groups may have changed over…”

Section: Patient and Treatment Characteristicsmentioning

confidence: 99%

Influence of Racial and Ethnic Identity on Overall Survival in Patients with Chronic Lymphocytic Leukemia

Vardell

Ermann

Fitzgerald

et al. 2022

Preprint

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Chronic lymphocytic leukemia (CLL) is the most prevalent adult leukemia, with the highest incidence in the White, non-Hispanic population. To better understand underrepresented minority CLL patients, patients diagnosed with CLL from 2004-2018 were identified in the National Cancer Database. Of 97 804 CLL patients, 90.7% of patients were White, 7.6% Black. Compared to White patients, Black patients were younger (median age 66 years vs. 70 years), more likely to have ≥1 comorbidity (27.9% vs. 21.3%), more likely to receive CLL-directed therapy at diagnosis (35.9% vs 23.6%; p<0.001), and had a shorter median OS of 7.0 years (95% CI 6.7-7.3) compared to White patients (9.1 years [95% CI 9.0-9.3]), p<0.001). On multivariate analysis, Black race was independently associated with shorter OS (HR 1.51 [95% CI 1.46-1.57], p<0.001), which was also demonstrated in a propensity score matched sample (matched by age, comorbidity, and socioeconomic features), where Black patients had shorter OS compared to White patients (HR 1.30 [95% CI 1.23-1.37, p<0.001]). In the largest study to date describing minority CLL patients, we found significantly reduced survival in Black CLL patients, highlighting the need for targeted efforts to provide equitable outcomes.

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Comorbidities at Diagnosis, Survival, and Cause of Death in Patients with Chronic Lymphocytic Leukemia: A Population-Based Study

Cited by 8 publications

References 35 publications

Do age, fitness, and concomitant medications influence management and outcomes of patients with CLL treated with ibrutinib?

Do age, fitness, and concomitant medications influence management and outcomes of patients with CLL treated with ibrutinib?

Prevalência e Diagnóstico de pacientes com Leucemia Linfocítica Crônica no Extremo Sul da Bahia, Bahia, Brasil

Influence of Racial and Ethnic Identity on Overall Survival in Patients with Chronic Lymphocytic Leukemia

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