Impact of comorbidities on overall survival in patients with chronic myeloid leukemia: results of the randomized CML Study IV
Impact of comorbidities on overall survival in patients with chronic myeloid leukemia: results of the randomized CML Study IV
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DOI：
10.1182/blood-2015-01-617993
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发表时间：
2015-07-02
期刊：
影响因子：
20.3
通讯作者：
Mueller, Martin C.
中科院分区：
文献类型：
--
作者：
Saussele, Susanne;Krauss, Marie-Paloma;Mueller, Martin C.
我们研究了慢性粒细胞白血病（CML）患者合并症对缓解率和总生存期（OS）的影响。CML研究IV是一项旨在优化伊马替尼治疗的随机5组试验，使用Charlson合并症指数（CCI）分析了诊断时的合并症; 1519例CML患者报告了511例合并症。年龄是863例患者的额外风险因素。结果CCI评分如下：CCI 2，n = 589; CCI 3或4，n = 599; CCI 5或6，n = 229;和CCI ≥ 7，n = 102。不同CCI组的患者之间在加速期、急变期或缓解率的累积发生率方面没有观察到差异。较高的CCI与较低的OS概率显著相关。CCI 2、3 - 4、5 - 6和≥ 7的患者8年OS概率分别为93.6%、89.4%、77.6%和46.4%。在多变量分析中，CCI是OS的最强预测因子，在去除其年龄相关成分后仍然有效。合并症对治疗成功没有影响，但对OS有负面影响，表明CML患者的生存更多地取决于合并症而不是CML本身。因此，OS可能不适合作为特定CML治疗的结局指标。该试验在www.clinicaltrials.gov上注册为#NCT00055874。
We studied the influence of comorbidities on remission rate and overall survival (OS) in patients with chronic myeloid leukemia (CML). Participants of the CML Study IV, a randomized 5-arm trial designed to optimize imatinib therapy, were analyzed for comorbidities at diagnosis using the Charlson Comorbidity Index (CCI); 511 indexed comorbidities were reported in 1519 CML patients. Age was an additional risk factor in 863 patients. Resulting CCI scores were as follows: CCI 2, n = 589; CCI 3 or 4, n = 599; CCI 5 or 6, n = 229; and CCI >= 7, n = 102. No differences in cumulative incidences of accelerated phase, blast crisis, or remission rates were observed between patients in the different CCI groups. Higher CCI was significantly associated with lower OS probabilities. The 8-year OS probabilities were 93.6%, 89.4%, 77.6%, and 46.4% for patients with CCI 2, 3 to 4, 5 to 6, and >= 7, respectively. In multivariate analysis, CCI was the most powerful predictor of OS, which was still valid after removal of its age-related components. Comorbidities have no impact on treatment success but do have a negative effect on OS, indicating that survival of patients with CML is determined more by comorbidities than by CML itself. OS may therefore be inappropriate as an outcome measure for specific CML treatments. The trial was registered at www.clinicaltrials.gov as #NCT00055874.