Comorbidities Signal Worse Outcomes in CLL After Targeted Treatment

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High comorbidity burden was associated with worse survival outcomes in patients with chronic lymphocytic leukemia who were treated with ibrutinib.
High comorbidity burden was associated with worse survival outcomes in patients with chronic lymphocytic leukemia who were treated with ibrutinib.

A multicenter, retrospective study showed that high comorbidity burden predicts worse survival outcomes in patients with chronic lymphocytic leukemia (CLL) treated with the targeted therapy ibrutinib.1 The study results were published in Cancer.

Patient medical records were reviewed from 5 academic medical centers in the United States to identify patients who had received treatment for CLL between 2000 and 2017.  Patient characteristics at the time of diagnosis and start of treatment were extracted from the medical records. For each patient, a Cumulative Illness Rating Scale (CIRS) score was calculated to represent comorbidity burden.

A total of 145 patients were included in the analysis. Patients had a median age of 90 years (range, 30-91) and a median number of 1 prior treatment (range, 0-8). Most patients received ibrutinib in the relapsed/refractory setting (80%), most had good performance status (92%), and half had Rai stage III or stage IV at treatment initiation. At the start of ibrutinib treatment, patients had a median CIRS score of 8; previously untreated patients had a score of 7.

A correlation between high comorbidity burden (CIRS score of at least 7) and worse median event-free survival was found compared with patients with a CIRS score of less than 7 (24 vs 37 months; P = .003). High comorbidity burden was also linked to worse 2-year overall survival (79% vs 100%; P = .005). As CIRS score increased, survival outcomes continued to worsen, independent of treatment setting and age. High comorbidity was also correlated with a higher risk of dose reduction and discontinuation.

“Comorbidities portend a poor prognosis among patients with CLL treated with ibrutinib,” the study authors wrote in their conclusion. “Prospective studies are needed to optimize the treatment of patients with CLL who have comorbidities.”

Reference

  1. Gordon MJ, Churnetski M, Alqahtani H, et al. Comorbidities predict inferior outcomes in chronic lymphocytic leukemia treated with ibrutinib. Cancer. 2018;124(15):3192-3200.

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