Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong, Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Korean J Intern Med. 2023 Sep;38(5):747-757. doi: 10.3904/kjim.2022.408. Epub 2023 Jun 26.
BACKGROUND/AIMS: Little attention is paid to chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) in Korea due to the rarity of the disease. With its rising incidence, we aimed to evaluate recent changes in treatment patterns and survival outcomes of patients with CLL/SLL.
A total of 141 patients diagnosed with CLL/SLL between January 2010 and March 2020 who received systemic therapy were analyzed in this multicenter retrospective study.
The median patient age was 66 years at diagnosis, and 68.1% were male. The median interval from diagnosis to initial treatment was 0.9 months (range: 0-77.6 months), and the most common treatment indication was progressive marrow failure (50.4%). Regarding first-line therapy, 46.8% received fludarabine, cyclophosphamide, plus rituximab (FCR), followed by chlorambucil (19.9%), and obinutuzumab plus chlorambucil (GC) (12.1%). The median progression-free survival (PFS) was 49.3 months (95% confidence interval [CI], 32.7-61.4), and median overall survival was not reached (95% CI, 98.4 mo- not reached). Multivariable analysis revealed younger age (≤ 65 yr) (hazard ratio [HR], 0.46; p < 0.001) and first-line therapy with FCR (HR, 0.64; p = 0.019) were independently associated with improved PFS. TP53 aberrations were observed in 7.0% (4/57) of evaluable patients. Following reimbursement, GC became the most common therapy among patients over 65 years and second in the overall population after 2017.
Age and reimbursement mainly influenced treatment strategies. Greater effort to apply risk stratifications into practice and clinical trials for novel agents could help improve treatment outcomes in Korean patients.
背景/目的：由于该病罕见，韩国对慢性淋巴细胞白血病/小淋巴细胞淋巴瘤（CLL/SLL）关注甚少。随着发病率的上升，我们旨在评估 CLL/SLL 患者治疗模式和生存结果的最新变化。
本多中心回顾性研究分析了 2010 年 1 月至 2020 年 3 月期间诊断为 CLL/SLL 并接受系统治疗的 141 例患者。
中位患者年龄为 66 岁，68.1%为男性。从诊断到初始治疗的中位间隔为 0.9 个月（范围：0-77.6 个月），最常见的治疗指征为骨髓衰竭进行性进展（50.4%）。一线治疗中，46.8%接受氟达拉滨、环磷酰胺联合利妥昔单抗（FCR），其次是苯丁酸氮芥（19.9%）和奥滨尤妥珠单抗联合苯丁酸氮芥（GC）（12.1%）。中位无进展生存期（PFS）为 49.3 个月（95%置信区间 [CI]，32.7-61.4），中位总生存期未达到（95%CI，98.4 mo-未达到）。多变量分析显示，年龄较小（≤65 岁）（风险比 [HR]，0.46；p<0.001）和一线 FCR 治疗（HR，0.64；p=0.019）与改善 PFS 独立相关。可评估的 57 例患者中有 7.0%（4/57）存在 TP53 异常。报销后，GC 成为 65 岁以上患者最常用的治疗方法，2017 年后在总体人群中排名第二。
年龄和报销主要影响治疗策略。更大的努力将风险分层应用于实践和新型药物的临床试验可能有助于改善韩国患者的治疗结果。
