Relationship between co-morbidities at diagnosis, survival and ultimate cause of death in patients with chronic lymphocytic leukaemia (CLL): a prospective cohort study
Relationship between co-morbidities at diagnosis, survival and ultimate cause of death in patients with chronic lymphocytic leukaemia (CLL): a prospective cohort study
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DOI：
10.1111/bjh.14785
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发表时间：
2017-08-01
影响因子：
6.5
通讯作者：
Shanafelt, Tait D.
中科院分区：
文献类型：
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作者：
Strati, Paolo;Parikh, Sameer A.;Shanafelt, Tait D.
大多数新诊断的慢性淋巴细胞白血病(CLL)患者的最终死亡原因及其与并存健康状况的关系尚不清楚。我们进行了一项前瞻性队列研究，系统地跟踪了2002年6月至2014年11月期间诊断为CLL的1143名患者。评估诊断为CLL时的并存健康状况及其与生存和死因的关系。总体而言，1061名(93%)患者在诊断CLL时至少有一种共病健康状况(中位数为3)。尽管如此，%的患者在诊断时有中低查尔逊共病指数(CCI)。中位随访6年后，225名患者死亡。85例(46%)死于慢性淋巴细胞性白血病，14例(8%)死于感染，35例(19%)死于其他癌症，50例(27%)死于其他健康状况。多变量分析显示，在诊断为CLL时，CCI评分越高，合并的主要健康状况越多，非CLL特异性生存期越短，但CLL特异性生存期越短。总之，CLL和CLL相关并发症(感染和第二癌症)是CLL患者的压倒性死亡原因，无论CCI评分和确诊时合并健康状况的数量如何。
The ultimate cause of death for most patients with newly diagnosed chronic lymphocytic leukaemia (CLL) and its relationship to co-morbid health conditions is poorly defined. We conducted a prospective cohort study that systematically followed 1143 patients diagnosed with CLL between June 2002 and November 2014. Comorbid health conditions at the time of CLL diagnosis and their relationship to survival and cause of death were evaluated. Collectively, 1061 (93%) patients had at least one co-morbid health condition at the time of CLL diagnosis (median number 3). Despite this, 89% of patients had a low-intermediate Charlson Comorbidity Index score (CCI) at diagnosis. After a median follow-up of 6 years, 225 patients have died. Death was due to CLL progression in 85 (46%) patients, infection in 14 (8%) patients, other cancer in 35 (19%) patients and comorbid health conditions in 50 (27%) patients. Higher CCI score and a greater number of major comorbid health conditions at the time of CLL diagnosis was associated with shorter non-CLL specific survival, but not with shorter CLL-specific survival on multivariate analysis. In conclusion, CLL and CLL-related complications (infections and second cancers) are the overwhelming cause of death in patients with CLL, regardless of CCI score and number of comorbid health conditions at diagnosis.