加拿大不列颠哥伦比亚省接受慢性淋巴细胞白血病治疗的患者，其年龄和治疗机构类型对结局的影响。

Impact of age and treatment institution type on outcomes of patients treated for chronic lymphocytic leukemia in British Columbia, Canada.

机构信息

Division of Hematology, Vancouver General Hospital, The University of British Columbia, Vancouver, British Columbia, Canada.

British Columbia Cancer - Vancouver, The University of British Columbia, Vancouver, British Columbia, Canada.

出版信息

Leuk Res. 2021 Apr;103:106538. doi: 10.1016/j.leukres.2021.106538. Epub 2021 Feb 18.

DOI:10.1016/j.leukres.2021.106538

PMID:33647819

Abstract

UNLABELLED

Older age has been shown to adversely impact overall survival (OS) in chronic lymphocytic leukemia (CLL) however, prior population-based studies did not analyze the impact of cytogenetic abnormalities or were prior to the availability of ibrutinib.

OBJECTIVES

i) We sought to compare outcomes of patients based on their age at treatment to examine if older age has an impact on OS in patients who were treated during the period when fludarabine-rituximab was the standard upfront therapy and when ibrutinib was first introduced and ii) compare outcomes based on whether the patient received primary treatment at an academic or community-based centre.

METHODS

The BC Provincial CLL Database, a population-based databasewas used to include patients who have received treatment in British Columbia (BC), Canada between 2004 and 2016.

RESULTS

A total of 1122 patients were included (<70 years at treatment, n = 589) with median age at diagnosis 66 years. Younger patients had higher Rai stage (55% vs. 44% stage I-II, p < 0.001), higher lymphocyte count at diagnosis (13 × 10/L vs. 10 × 10/L, p = 0.004), greater proportion with B-symptoms at diagnosis (15% vs 10%, p = 0.004), shorter time from diagnosis to treatment (13.9 months vs. 21.4 months, p = 0.001), higher proportion treated at an academic centre (79% vs. 69%, p < 0.001) and more were treated with fludarabine-rituximab or FCR (69% vs. 42%, p < 0.001) compared to older patients. Older patients had both a significantly (p < 0.001) shorter OS from treatment start (4.7 years) and disease specific survival (8.1 years) than younger patients (median OS and DSS not reached). Of interest, there was no difference in OS between patients treated at an academic centre or community centre (p = 0.087). First-line treatment with chemoimmunotherapy improved OS (HR 0.465, 95% CI: 0.381-.567).

CONCLUSIONS

Older age but not treatment-institution type adversely impacts overall survival and CLL survival in treated patients in BC.

摘要

未注明

年龄较大已被证明会对慢性淋巴细胞白血病（CLL）的总生存期（OS）产生不利影响，但是，先前的基于人群的研究并未分析细胞遗传学异常的影响，或者是在伊布替尼可用之前进行的。

目的

i）我们试图根据治疗时的年龄比较患者的结局，以检查在氟达拉滨-利妥昔单抗作为一线治疗药物和伊布替尼首次引入时接受治疗的患者中，年龄较大是否对 OS 有影响；以及 ii）根据患者是否在学术或社区中心接受一线治疗来比较结局。

方法

使用不列颠哥伦比亚省 CLL 数据库（一个基于人群的数据库）纳入 2004 年至 2016 年间在加拿大不列颠哥伦比亚省（BC）接受治疗的患者。

结果

共纳入 1122 例患者（治疗时<70 岁，n = 589），中位诊断年龄为 66 岁。年轻患者的 Rai 分期更高（55%比 44%为 I-II 期，p < 0.001），诊断时淋巴细胞计数更高（13×10/L 比 10×10/L，p = 0.004），诊断时 B 症状比例更高（15%比 10%，p = 0.004），从诊断到治疗的时间更短（13.9 个月比 21.4 个月，p = 0.001），在学术中心接受治疗的比例更高（79%比 69%，p < 0.001），接受氟达拉滨-利妥昔单抗或 FCR 治疗的比例更高（69%比 42%，p < 0.001）。与年轻患者相比，老年患者的治疗开始后（p < 0.001）总生存期（OS）和疾病特异性生存期（DSS）均显著缩短（4.7 年和 8.1 年）。有趣的是，在学术中心或社区中心接受治疗的患者之间 OS 无差异（p = 0.087）。一线化疗免疫治疗可改善 OS（HR 0.465，95%CI：0.381-0.567）。