Atrial fibrillation in patients with chronic lymphocytic leukemia (CLL) treated with ibrutinib: risk prediction, management, and clinical outcomes.
Atrial fibrillation in patients with chronic lymphocytic leukemia (CLL) treated with ibrutinib: risk prediction, management, and clinical outcomes.
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DOI：
10.1007/s00277-020-04094-3
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发表时间：
2021-01
影响因子：
3.5
通讯作者：
Parikh SA
中科院分区：
文献类型：
--
作者：
Archibald WJ;Rabe KG;Kabat BF;Herrmann J;Ding W;Kay NE;Kenderian SS;Muchtar E;Leis JF;Wang Y;Chanan-Khan AA;Schwager SM;Koehler AB;Fonder AL;Slager SL;Shanafelt TD;Call TG;Parikh SA
伊布鲁替尼治疗与慢性淋巴细胞白血病(CLL)患者发生房颤(AF)的风险增加有关。这些患者发生房颤的风险评估工具和结果没有得到很好的描述。我们对2012年10月至2018年11月在梅奥诊所接受伊布鲁替尼治疗的CLL患者进行了回顾性回顾。298例患者接受伊布鲁替尼治疗的中位时间为19个月(0.23-69.7个月)。51例患者发生治疗后房颤；治疗后6个月、1年和2年发生房颤的风险分别为9%、12%和16%。在多变量分析中，以下因素与治疗后出现房颤的风险增加有关：既往房颤病史(危险比[HR]3.5，p=0.0072)和心力衰竭(HR 3.4，p=0.0028)。大多数患者能够继续接受伊布鲁替尼治疗(剂量减少了43%)。在调整了年龄、以前的治疗状态、TP53中断、心力衰竭、瓣膜疾病和既往房颤病史后，发生治疗后的房颤与较短的无事件生存期(EFS；HR 2.0，p=0.02)和较短的总生存期(OS；HR 3.2，p=0.001)相关。在接受伊布鲁替尼治疗的患者中，患者的合并症，而不是CLL相关因素，可以预测治疗后出现房颤的风险。尽管绝大多数治疗后出现的房颤患者能够继续使用伊布鲁替尼(剂量减少43%)，但治疗后出现的房颤似乎与较差的预后相关，与其他不良预后因素无关。
Ibrutinib therapy is associated with an increased risk of atrial fibrillation (AF) in chronic lymphocytic leukemia (CLL). Risk assessment tools and outcomes of AF in these patients are not well described. We performed a retrospective review of patients with CLL treated with ibrutinib at Mayo Clinic between October 2012 and November 2018. Two hundred ninety-eight patients were identified with a median time on ibrutinib of 19 months (range 0.23–69.7 months). Fifty-one patients developed treatment-emergent AF; the risk of treatment-emergent AF at 6 months, 1 year, and 2 years was 9%, 12%, and 16%, respectively. The following were associated with an increased risk of treatment-emergent AF on multivariable analyses: past history of AF (hazard ratio [HR] 3.5, p = 0.0072) and heart failure (HR 3.4, p = 0.0028). Most patients are able to continue ibrutinib therapy (dose reduced in 43%). Development of treatment-emergent AF was associated with shorter event-free survival (EFS; HR 2.0, p = 0.02) and shorter overall survival (OS; HR 3.2, p = 0.001), after adjusting for age, prior treatment status, TP53 disruption, heart failure, valvular disease, and past history of AF. Patient comorbidities, rather than CLL-related factors, predict risk of treatment-emergent AF in patients treated with ibrutinib. Although the vast majority of patients with treatment-emergent AF are able to continue ibrutinib (with dose reduction in 43%), treatment-emergent AF appears to be associated with worse outcomes, independent of other adverse prognostic factors.
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影响因子：
10.1
作者：
Lipsky, Andrew H.;Farooqui, Mohammed Z. H.;Wiestner, Adrian
通讯作者：
Wiestner, Adrian
影响因子：
10.1
作者：
Brown JR;Moslehi J;O'Brien S;Ghia P;Hillmen P;Cymbalista F;Shanafelt TD;Fraser G;Rule S;Kipps TJ;Coutre S;Dilhuydy MS;Cramer P;Tedeschi A;Jaeger U;Dreyling M;Byrd JC;Howes A;Todd M;Vermeulen J;James DF;Clow F;Styles L;Valentino R;Wildgust M;Mahler M;Burger JA
通讯作者：
Burger JA
影响因子：
6.5
作者：
Parikh SA;Rabe KG;Call TG;Zent CS;Habermann TM;Ding W;Leis JF;Schwager SM;Hanson CA;Macon WR;Kay NE;Slager SL;Shanafelt TD
通讯作者：
Shanafelt TD
影响因子：
6.5
作者：
Hampel PJ;Larson MC;Kabat B;Call TG;Ding W;Kenderian SS;Bowen D;Boysen J;Schwager SM;Leis JF;Chanan-Khan AA;Muchtar E;Hanson CA;Slager SL;Kay NE;Chaffee KG;Shanafelt TD;Parikh SA
通讯作者：
Parikh SA
影响因子：
1.2
作者：
Khalid, Sidra;Yasar, Samin;Daw, Hamed
通讯作者：
Daw, Hamed