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Immunoglobulin Gene Sequence Analysis In Chronic Lymphocytic Leukemia: From Patient Material To Sequence Interpretation
Published on: November 26, 2018
Comorbid conditions and survival in unselected, newly diagnosed patients with chronic lymphocytic leukemia
Paul Thurmes1, Timothy Call, Susan Slager
1Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Insights
Most newly diagnosed chronic lymphocytic leukemia (CLL) patients have comorbidities, but age and Rai risk stage are more critical for predicting survival. Further research is needed for clinical trials accommodating these patients.
Area of Science:
- Hematology
- Oncology
Background:
- Comorbidities are common in chronic lymphocytic leukemia (CLL) but their spectrum and prognostic impact are not well-defined.
- Understanding comorbidity prevalence is crucial for managing CLL patients.
Purpose of the Study:
- To investigate the prevalence and prognostic significance of comorbidities in patients with newly diagnosed CLL.
- To identify factors influencing overall survival in this patient population.
Main Methods:
- Retrospective review of 373 local/non-referred patients with newly diagnosed CLL evaluated at Mayo Clinic between 1995 and 2006.
- Analysis of comorbidity data and correlation with overall survival using multi-factor analysis.
Main Results:
- 89% of patients had at least one comorbidity, and 46% had a major comorbidity at diagnosis.
- 26% of patients did not meet NCI working group guidelines for clinical trial participation.
- Age and Rai risk category were the only significant predictors of overall survival.
Conclusions:
- Comorbidities are highly prevalent in newly diagnosed CLL patients.
- Age and disease stage are more important prognostic factors than comorbidities.
- There is a need for clinical trials designed for patients with comorbidities who may not meet traditional eligibility criteria.
Abstract:
Little is known about the spectrum or frequency of comorbidities in patients with chronic lymphocytic leukemia (CLL). We investigated the prevalence and prognostic implications of comorbidities in patients with newly diagnosed CLL. Local/non-referred patients with CLL evaluated by a hematologist at Mayo Clinic within 1 year of diagnosis were eligible for this retrospective review. Of 1195 individuals evaluated for newly-diagnosed CLL between 1995 and 2006, 373 (31%) were local/non-referred. At diagnosis, 89% of these patients had one or more comorbidities, and 46% had at least one major comorbidity. Twenty-six percent of patients failed to meet NCI working group guidelines to participate in a clinical trial. On multi-factor analysis, Rai risk category (1.39 per each risk category increase; p < 0.0001) and age (1.056 per year increase; p < 0.0001) were the only factors associated with overall survival. We conclude that, although common, comorbid conditions are less important than age and stage in predicting prognosis in newly diagnosed patients with CLL. Clinical trials evaluating treatments that are designed to be tolerated by patients who do not meet traditional clinical trial eligibility criteria are needed.
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