Chandrasekar Muthiah , Ravi Narra , Ehab Atallah , Wanlin Juan , Aniko Szabo , Guru Subramanian Guru Murthy
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引用次数: 0
摘要
在过去十年中,BTK 和 BCL-2 抑制剂等新型药物彻底改变了 CLL/SLL 的治疗方法,临床试验显示,与化疗药物相比,这些药物可提高总生存率。然而,目前还缺乏对这些药物是否改善了人群总生存率的研究。我们对美国国家癌症研究所监测流行病学和最终结果(SEER)数据库中登记的 CLL/SLL 患者进行了回顾性分析,分析了新型药物上市前后的总生存期(OS)以及人口统计学信息,从而对此进行了评估。我们的结果显示,中位OS随着时间的推移明显改善[7.8年(2000-2005年)、9.1年(2006-2013年)、未达到(2014-2018年)(p <0.001)]。与2014-2018年的诊断相比,早期诊断与较高的死亡风险相关(2000-2005年-HR 1.32,95 % CI 1.28-1.37,p <0.001:2006-2013年-HR 1.09,95 % CI 1.06-1.13,p <0.001)。85岁的患者死亡率较低,而家庭收入中位数为75000美元的患者死亡率较高。我们的研究提供了真实世界的数据,表明生存率的提高可能是多因素促成的,包括新型药物的可用性、更好的监测和支持性护理。这些数据还显示,由于社会经济状况和人口因素的影响,CLL/SLL 患者的总生存率存在差异。
Evaluating population-level outcomes in Chronic Lymphocytic leukemia in the era of novel therapies using the SEER registry
In the last decade, novel agents such as BTK and BCL-2 inhibitors have revolutionized treatment of CLL/SLL, with clinical trials showing improved overall survival compared to chemotherapeutic agents. However, studies examining whether they have improved overall survival at the population level are lacking. We evaluated this by conducting a retrospective analysis of CLL/SLL patients registered in the National Cancer Institute’s surveillance epidemiology and end results (SEER) database, analyzing overall survival (OS) in periods pre- and post-availability of novel agents, along with demographic information. Our results showed that median OS significantly improved over time [7.8 years (2000–2005), 9.1 years (2006–2013), and not reached (2014–2018) (p < 0.001)]. Compared to diagnosis in 2014–2018, diagnosis in earlier periods was associated with higher mortality risk (2000–2005-HR 1.32, 95 % CI 1.28–1.37, p < 0.001: 2006–2013-HR 1.09, 95 % CI 1.06–1.13, p < 0.001). Lower mortality risk was seen in patients age < 85 years whereas median household income of <$75000 was associated with higher mortality. Our study provides real-world data suggesting a possible multifactorial contribution to improvement in survival, including availability of novel agents, better monitoring, and supportive care. They also show discrepancies in overall survival for CLL/SLL patients due to socioeconomic status and demographic factors.
期刊介绍:
Leukemia Research an international journal which brings comprehensive and current information to all health care professionals involved in basic and applied clinical research in hematological malignancies. The editors encourage the submission of articles relevant to hematological malignancies. The Journal scope includes reporting studies of cellular and molecular biology, genetics, immunology, epidemiology, clinical evaluation, and therapy of these diseases.