Mapping comorbidity in chronic lymphocytic leukemia: impact of individual comorbidities on treatment, mortality, and causes of death

Emelie Curovic Rotbain; Carsten Utoft Niemann; Klaus Rostgaard; Caspar da Cunha-Bang; Henrik Hjalgrim; Henrik Frederiksen

doi:10.1038/s41375-021-01156-x

Mapping comorbidity in chronic lymphocytic leukemia: impact of individual comorbidities on treatment, mortality, and causes of death

Emelie Curovic Rotbain^*
, Carsten Utoft Niemann
, Klaus Rostgaard
, Caspar da Cunha-Bang
, Henrik Hjalgrim
, Henrik Frederiksen

^*Kontaktforfatter

Rigshospitalet
Statens Serum Institut
Københavns Universitet

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

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Abstract

Comorbid conditions are highly prevalent in chronic lymphocytic leukemia (CLL), nevertheless, detailed information on the association of specific comorbidities with CLL prognosis is missing. Using Danish, nation-wide registers, we followed consecutive patients from CLL-diagnosis in 1997–2018, until death or end of follow-up. Sub-grouping of comorbidities was defined using a modified Charlson comorbidity index. Patients were matched on sex, date of birth (±1 month), and region of residency with up to ten comparators from the general population. In total, 9170 patients with CLL were included in the study, with a median of 5.0 years of follow-up. All comorbid conditions studied were individually associated with increased mortality, and many also with increased cause-specific mortality, related or unrelated to CLL. Comorbidity correlated with increased mortality from infections and cardiovascular disease. CLL patients, particularly older, had a significant loss of lifetime compared with the general population. This study highlights a large subgroup of comorbid CLL patients with an unmet treatment-need and missing efficacy and safety data on treatment, who are under-prioritized in clinical trials. Also, studies assessing interventions that may provide better tolerability of treatment in older or comorbid patients, with cancer in general, and CLL in particular, are warranted.

Originalsprog	Engelsk
Tidsskrift	Leukemia
Vol/bind	35
Udgave nummer	9
Sider (fra-til)	2570-2580
ISSN	0887-6924
DOI	https://doi.org/10.1038/s41375-021-01156-x
Status	Udgivet - sep. 2021

Bibliografisk note

Funding Information:
Acknowledgements This study was supported in part by grants from Novo Nordisk Foundation grant NNF16OC0019302 and AstraZeneca to CUN and Neye Fonden to HHJ. AstraZeneca was provided with the opportunity to prospectively review the manuscript. The funding sources had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

Funding Information:
Conflict of interest ECR received consultancy fees or travel grants from Abbvie, Janssen, and AstraZeneca. HF received support outside this work from Alexion, Gilead, Abbvie, Janssen Pharmaceuticals, and Novartis. CC-B received consultancy fees and/or travel grants from Abbvie, and Gilead. CUN received support from Novo Nordisk Foundation NNF16OC0019302 and AstraZeneca within this work. CUN received support, consultancy fees, or travel grants from Abbvie, Gilead, Janssen, Roche, CSL Behring, Acerta, Genmab, Sunesis, and Astra Zeneca outside this work. HHJ received support from Neye Fonden outside this work. KR reports no conflicts of interest.

Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Nature Limited part of Springer Nature.

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

Finansiering

Acknowledgements This study was supported in part by grants from Novo Nordisk Foundation grant NNF16OC0019302 and AstraZeneca to CUN and Neye Fonden to HHJ. AstraZeneca was provided with the opportunity to prospectively review the manuscript. The funding sources had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. Conflict of interest ECR received consultancy fees or travel grants from Abbvie, Janssen, and AstraZeneca. HF received support outside this work from Alexion, Gilead, Abbvie, Janssen Pharmaceuticals, and Novartis. CC-B received consultancy fees and/or travel grants from Abbvie, and Gilead. CUN received support from Novo Nordisk Foundation NNF16OC0019302 and AstraZeneca within this work. CUN received support, consultancy fees, or travel grants from Abbvie, Gilead, Janssen, Roche, CSL Behring, Acerta, Genmab, Sunesis, and Astra Zeneca outside this work. HHJ received support from Neye Fonden outside this work. KR reports no conflicts of interest.

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10.1038/s41375-021-01156-x

Open Access VersionAccepteret manuskript, 539 KB

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Tjek adgangen til materialet i Syddansk Universitetsbiblioteks søgemaskine

1 Ph.d.-afhandling

Comorbidity and survival in chronic lymphocytic leukemia
Rotbain, E., 13. dec. 2021, Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet. 148 s.
Publikation: Afhandling › Ph.d.-afhandling

Citationsformater

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abstract = "Comorbid conditions are highly prevalent in chronic lymphocytic leukemia (CLL), nevertheless, detailed information on the association of specific comorbidities with CLL prognosis is missing. Using Danish, nation-wide registers, we followed consecutive patients from CLL-diagnosis in 1997{\textendash}2018, until death or end of follow-up. Sub-grouping of comorbidities was defined using a modified Charlson comorbidity index. Patients were matched on sex, date of birth (±1 month), and region of residency with up to ten comparators from the general population. In total, 9170 patients with CLL were included in the study, with a median of 5.0 years of follow-up. All comorbid conditions studied were individually associated with increased mortality, and many also with increased cause-specific mortality, related or unrelated to CLL. Comorbidity correlated with increased mortality from infections and cardiovascular disease. CLL patients, particularly older, had a significant loss of lifetime compared with the general population. This study highlights a large subgroup of comorbid CLL patients with an unmet treatment-need and missing efficacy and safety data on treatment, who are under-prioritized in clinical trials. Also, studies assessing interventions that may provide better tolerability of treatment in older or comorbid patients, with cancer in general, and CLL in particular, are warranted.",

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note = "Funding Information: Acknowledgements This study was supported in part by grants from Novo Nordisk Foundation grant NNF16OC0019302 and AstraZeneca to CUN and Neye Fonden to HHJ. AstraZeneca was provided with the opportunity to prospectively review the manuscript. The funding sources had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. Funding Information: Conflict of interest ECR received consultancy fees or travel grants from Abbvie, Janssen, and AstraZeneca. HF received support outside this work from Alexion, Gilead, Abbvie, Janssen Pharmaceuticals, and Novartis. CC-B received consultancy fees and/or travel grants from Abbvie, and Gilead. CUN received support from Novo Nordisk Foundation NNF16OC0019302 and AstraZeneca within this work. CUN received support, consultancy fees, or travel grants from Abbvie, Gilead, Janssen, Roche, CSL Behring, Acerta, Genmab, Sunesis, and Astra Zeneca outside this work. HHJ received support from Neye Fonden outside this work. KR reports no conflicts of interest. Publisher Copyright: {\textcopyright} 2021, The Author(s), under exclusive licence to Springer Nature Limited part of Springer Nature. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

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N2 - Comorbid conditions are highly prevalent in chronic lymphocytic leukemia (CLL), nevertheless, detailed information on the association of specific comorbidities with CLL prognosis is missing. Using Danish, nation-wide registers, we followed consecutive patients from CLL-diagnosis in 1997–2018, until death or end of follow-up. Sub-grouping of comorbidities was defined using a modified Charlson comorbidity index. Patients were matched on sex, date of birth (±1 month), and region of residency with up to ten comparators from the general population. In total, 9170 patients with CLL were included in the study, with a median of 5.0 years of follow-up. All comorbid conditions studied were individually associated with increased mortality, and many also with increased cause-specific mortality, related or unrelated to CLL. Comorbidity correlated with increased mortality from infections and cardiovascular disease. CLL patients, particularly older, had a significant loss of lifetime compared with the general population. This study highlights a large subgroup of comorbid CLL patients with an unmet treatment-need and missing efficacy and safety data on treatment, who are under-prioritized in clinical trials. Also, studies assessing interventions that may provide better tolerability of treatment in older or comorbid patients, with cancer in general, and CLL in particular, are warranted.

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Mapping comorbidity in chronic lymphocytic leukemia: impact of individual comorbidities on treatment, mortality, and causes of death

Abstract

Bibliografisk note

Finansiering

Dokumenter og links

SDU link

Fingeraftryk

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Comorbidity and survival in chronic lymphocytic leukemia

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