Survival, causes of death, and the prognostic role of comorbidities in chronic lymphocytic leukemia in the pre-ibrutinib era: A population-based study.

Autor: Steingrímsson V; Faculty of Medicine, University of Iceland, Reykjavik, Iceland., Lund SH; Faculty of Medicine, University of Iceland, Reykjavik, Iceland., Dickman PW; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden., Weibull CE; Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden., Björkholm M; Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden., Landgren O; Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA., Kristinsson SY; Faculty of Medicine, University of Iceland, Reykjavik, Iceland.; Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
Jazyk: angličtina
Zdroj: European journal of haematology [Eur J Haematol] 2022 Feb; Vol. 108 (2), pp. 145-153. Date of Electronic Publication: 2021 Nov 11.
DOI: 10.1111/ejh.13720
Abstrakt: Objective: To evaluate temporal trends in survival and causes of death in patients with chronic lymphocytic leukemia (CLL) in a nationwide study.
Methods: The cohort consisted of 13,009 Swedish CLL patients diagnosed 1982-2013. Relative survival (RS) and excess mortality rate ratios (EMRR) with 95% confidence intervals (95% CIs) were estimated using flexible parametric survival models. Cause-specific hazard ratios (HRs) were estimated for the linear effect of 10-year increase in year of diagnosis.
Results: The excess mortality decreased comparing 2003-2013 to 1982-1992 (EMRR = 0.53, 95% CI 0.48-0.58). The 5-year RS increased between 1982 and 2012 for patients >51 years at diagnosis and improved for patients ≤51 years after 2002. The rate of CLL-specific deaths decreased over time (HR = 0.78, 95% CI 0.75-0.81). Compared to patients with no comorbidity, patients with 1 and 2+ Charlson Comorbidity Index points had HR = 1.35 (95% CI 1.25-1.45) and HR = 1.47 (95% CI 1.37-1.57) for CLL-related mortality, respectively.
Conclusion: Survival in CLL patients improved in the era of chemoimmunotherapy, and this was largely explained by reduced CLL-related mortality. The increased rate of CLL-related mortality in patients with comorbidities emphasizes the importance of the newer and better tolerated targeted therapy.
(© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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