Comorbidities at Diagnosis, Survival, and Cause of Death in Patients with Chronic Lymphocytic Leukemia: A Population-Based Study.

Alicia Villavicencio,Montse Puigdemont,Rafael Marcos-Gragera,Anna Vidal,Marta Solans,Josep Maria Roncero,Marc Saez,Lluís Zacarías-Pons

doi:10.3390/ijerph18020701

Abstract

This study aimed to examine the prevalence of comorbidities in patients diagnosed with chronic lymphocytic leukemia (CLL), and to assess its influence on survival and cause-specific mortality at a population-based level. Incident CLL cases diagnosed in the Girona province (Spain) during 2008–2016 were extracted from the Girona Cancer Registry. Rai stage and presence of comorbidities at diagnosis, further categorized using the Charlson comorbidity index (CCI), were obtained from clinical records. Observed (OS) and relative survival (RS) were estimated and Cox’s proportional hazard models were used to explore the impact of comorbidity on mortality. Among the 400 cases included in the study, 380 (99.5%) presented at least one comorbidity at CLL diagnosis, with diabetes without end organ damage (21%) being the most common disease. 5-year OS and RS were 68.8 (95% CI: 64.4–73.6) and 99.5 (95% CI 3.13–106.0), respectively, which decreased markedly with increasing CCI, particularly in patients with CCI ≥ 3. Multivariate analysis identified no statistically significant association between the CCI and overall CLL-related or CLL-unrelated mortality. In conclusion, a high CCI score negatively influenced the OS and RS of CLL patients, yet its effect on mortality was statistically non-significant when also considering age and the Rai stage.

Highlights

A total of 400 incident Chronic lymphocytic leukemia (CLL) with a median follow-up time of 5.2 years were included in the study
Patients with higher Charlson comorbidity index (CCI) score were older and more prone to be diagnosed with advanced Rai stages, while we did not find differences according to sex or period of diagnosis
CLL—chronic lymphocytic leukemia; 95% confidence intervals (95% CI), 95% confidence interval; CCI—Charlson comorbidity index; higher overall mortality (HR)—hazard ratio. 1 p-value of the Cox proportional model fitted with the ordinal variable as continuous to test for the lineal trend

Summary

Introduction

Chronic lymphocytic leukemia (CLL) is the most common leukemia in Western countries, with an incidence of 3.79 [1] and a 5-year relative survival (RS) of 69 years (95% confidence interval (CI):68.1; 69.8) [2], in 2006–2008 in Europe. CLL is often classified as an indolent disease with a relatively good prognosis, it has an unpredictable clinical course and can become resistant to conventional treatments. Despite recent progress in its management, this disease remains incurable, and patients with CLL still have a reduced life expectancy as compared to the general population [3]. Patients are often compromised by concurrent pathological conditions [5], and

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