Mayo Clinic, Jacksonville, FL 32224, USA.
Genentech, South San Francisco, CA 94080, USA.
J Comp Eff Res. 2024 Feb;13(2):e230119. doi: 10.57264/cer-2023-0119. Epub 2024 Jan 31.
Improved management of chronic lymphocytic leukemia (CLL) has resulted in a growing population of CLL survivors; these patients have a higher risk of developing second primary malignancies (SPMs) versus the general population. This retrospective cohort study aims to assess the timing, frequency, incidence and types of SPMs in treated and untreated patients with CLL in the USA, using the Surveillance, Epidemiology, and End Results (SEER) Medicare database, which links a nationally representative cancer registry with Medicare claims data. Patients aged ≥66 years with newly diagnosed CLL between 1 January 2010 and 31 December 2016, who were enrolled in Parts A and B of Medicare for ≥12 months pre-diagnosis of CLL were selected from the database. Patients were assessed for ≥36 months until the end of continuous enrollment in Medicare Parts A, B and D, a switch to a health maintenance organization, death, or end of the study period (December 2019). Of 3053 patients included in the analyses, 620 (20.3%) were treated and 2433 (79.7%) were untreated within 36 months of diagnosis. Overall, 638 (20.9%) patients developed a SPM, 26.8% of patients in the treated cohort and 19.4% of patients in the untreated cohort. The most common SPMs for both cohorts were squamous cell carcinoma and acute myeloid leukemia. Among the 166 treated patients who developed a SPM, a greater proportion developed their first SPM after treatment initiation versus those who developed their first SPM prior to treatment initiation (p < 0.001). A significantly lower percentage of patients who received targeted therapy developed a SPM (p < 0.05) versus patients treated with anti-CD20 + chemotherapy. Findings indicate that treatment type and timing can affect SPM development in patients with CLL. Combined with previous findings, this can help inform best practices in monitoring for SPM in patients with CLL.
慢性淋巴细胞白血病（CLL）的管理得到改善，导致 CLL 幸存者人数不断增加；与普通人群相比，这些患者发生第二原发恶性肿瘤（SPM）的风险更高。本回顾性队列研究旨在使用监测、流行病学和最终结果（SEER）医疗保险数据库评估美国接受和未接受治疗的 CLL 患者 SPM 的发生时间、频率、发生率和类型，该数据库将全国代表性癌症登记处与医疗保险索赔数据相关联。 从数据库中选择了 2010 年 1 月 1 日至 2016 年 12 月 31 日期间新诊断为 CLL 的年龄≥66 岁的患者，这些患者在 CLL 诊断前至少 12 个月参加了医疗保险 A 部分和 B 部分，并至少连续 36 个月接受评估月在 Medicare 部分 A、B 和 D 中登记、转到健康维护组织、死亡或研究结束（2019 年 12 月）。 在纳入分析的 3053 名患者中，620 名（20.3%）在诊断后 36 个月内接受治疗，2433 名（79.7%）未接受治疗。总体而言，638 名（20.9%）患者发生了 SPM，治疗队列中 26.8%的患者和未治疗队列中 19.4%的患者发生了 SPM。两个队列中最常见的 SPM 都是鳞状细胞癌和急性髓系白血病。在 166 名接受治疗并发生 SPM 的患者中，与治疗前发生首次 SPM 的患者相比，治疗后发生首次 SPM 的患者比例更高（p<0.001）。与接受抗 CD20+化疗治疗的患者相比，接受靶向治疗的患者发生 SPM 的比例显著较低（p<0.05）。 研究结果表明，治疗类型和时间可能会影响 CLL 患者 SPM 的发生。结合以往的研究结果，可以帮助为 CLL 患者监测 SPM 提供最佳实践。
