Characterizing and prognosticating chronic lymphocytic leukemia in the elderly: prospective evaluation on 455 patients treated in the United States

BMC Cancer

Research Article

Chadi Nabhan¹  Pavel Kiselev²  Arlene S. Swern²  Shriya Bhushan²  Kristen Sullivan³  E. Dawn Flick⁴  Anthony Mato⁵  Matthew S. Davids⁶  Christopher R. Flowers⁷  Nicole Lamanna⁸  David L. Grinblatt⁹  Mark A. Weiss^1,10  Jeff P. Sharman^1,11 

[1] Cardinal Health Specialty Solutions, 60085, Waukegan, IL, USA;Celgene Corporation, 07901, Summit, NJ, USA;Celgene Corporation, 66210, Overland Park, KS, USA;Celgene Corporation, San Francisco, CA, USA;Center for CLL, Abramson Cancer Center, University of Pennsylvania, 19104, Philadelphia, PA, USA;Dana-Farber Cancer Institute, 02215, Boston, MA, USA;Emory University, 30322, Atlanta, GA, USA;Leukemia Service, Hematologic Malignancies Section, Division of Hematology/Oncology, New York-Presbyterian Hospital/Columbia University Medical Center, 10032, New York, NY, USA;NorthShore University HealthSystem, 60201, Evanston, IL, USA;Thomas Jefferson University, 19107, Philadelphia, PA, USA;Willamette Valley Cancer Institute and Research Center, Springfield, OR, USA;

关键词: Chronic lymphocytic leukemia;    Connect® CLL registry;    Elderly;    Prognostic;    Chemoimmunotherapy;   

DOI  :  10.1186/s12885-017-3176-x

 received in 2016-09-28, accepted in 2017-03-08,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundMedian age at diagnosis of patients with chronic lymphocytic leukemia (CLL) is > 70 years. However, the majority of clinical trials do not reflect the demographics of CLL patients treated in the community. We examined treatment patterns, outcomes, and disease-related mortality in patients ≥ 75 years with CLL (E-CLL) in a real-world setting.MethodsThe Connect® CLL registry is a multicenter, prospective observational cohort study, which enrolled 1494 adult patients between 2010–2014, at 199 US sites. Patients with CLL were enrolled within 2 months of initiating first line of therapy (LOT1) or a subsequent LOT (LOT ≥ 2). Kaplan–Meier methods were used to evaluate overall survival. CLL- and infection-related mortality were assessed using cumulative incidence functions (CIF) and cause-specific hazards. Logistic regression was used to develop a classification model.ResultsA total of 455 E-CLL patients were enrolled; 259 were enrolled in LOT1 and 196 in LOT ≥ 2. E-CLL patients were more likely to receive rituximab monotherapy (19.3 vs. 8.6%; p < 0.0001) and chemotherapy-alone regimens (p < 0.0001) than younger patients. Overall and complete responses were lower in E-CLL patients than younger patients when given similar regimens. With a median follow-up of 3 years, CLL-related deaths were higher in E-CLL patients than younger patients in LOT1 (12.6 vs. 5.1% p = 0.0005) and LOT ≥ 2 (31.3 vs. 21.5%; p = 0.0277). Infection-related deaths were also higher in E-CLL patients than younger patients in LOT1 (7.4 vs. 2.7%; p = 0.0033) and in LOT ≥ 2 (16.2 vs. 11.2%; p = 0.0786). A prognostic score for E-CLL patients was developed: time from diagnosis to treatment < 3 months, enrollment therapy other than bendamustine/rituximab, and anemia, identified patients at higher risk of inferior survival. Furthermore, higher-risk patients experienced an increased risk of CLL- or infection-related death (30.6 vs 10.3%; p = 0.0006).ConclusionCLL- and infection-related mortality are higher in CLL patients aged ≥ 75 years than younger patients, underscoring the urgent need for alternative treatment strategies for these understudied patients.Trial RegistrationThe Connect CLL registry was registered at clinicaltrials.gov: NCT01081015 on March 4, 2010.

【 授权许可】

CC BY   
© The Author(s). 2017