Comorbidities predict inferior outcomes in chronic lymphocytic leukemia treated with ibrutinib

Max J. Gordon, Michael Churnetski, Hamood Alqahtani, Xavier Rivera, Adam Kittai, Stephen M. Amrock, Spencer James, Sheila Hoff, Sudhir Manda, Stephen Spurgeon, Michael Choi, Jonathon B. Cohen, Daniel Persky, Alexey Danilov

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND: Most patients with chronic lymphocytic leukemia (CLL) present with multiple comorbidities. Although comorbidities negatively affect outcomes for patients treated with chemoimmunotherapy, their impact on patients who receive targeted therapies is unknown. METHODS: This multicenter, retrospective analysis evaluated the significance of comorbidities, as assessed by the Cumulative Illness Rating Scale (CIRS), among patients with CLL treated with ibrutinib. RESULTS: One hundred forty-five patients received ibrutinib (80% in a relapsed/refractory setting). A high burden of comorbidities (CIRS score ≥ 7) was associated with inferior median event-free survival (EFS; 24 vs 37 months; P =.003) and 2-year overall survival (OS; 79% vs 100%; P =.005). In an adjusted Cox model, both EFS and OS worsened with an incremental increase in the CIRS score. Furthermore, comorbidities were associated with an increased risk of ibrutinib dose reduction and therapy discontinuation. CIRS was predictive in both frontline and relapsed CLL, regardless of patient age. CONCLUSIONS: Comorbidities portend a poor prognosis among patients with CLL treated with ibrutinib. Prospective studies are needed to optimize the treatment of patients with CLL who have comorbidities. Cancer 2018.

Original languageEnglish (US)
Pages (from-to)3192-3200
Number of pages9
JournalCancer
Volume124
Issue number15
DOIs
StatePublished - Aug 1 2018

Fingerprint

B-Cell Chronic Lymphocytic Leukemia
Comorbidity
PCI 32765
Proportional Hazards Models
Disease-Free Survival
Therapeutics
Prospective Studies
Survival

Keywords

  • chronic lymphocytic leukemia (CLL)
  • Cumulative Illness Rating Scale (CIRS)
  • geriatric oncology
  • ibrutinib
  • targeted agents

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Gordon, M. J., Churnetski, M., Alqahtani, H., Rivera, X., Kittai, A., Amrock, S. M., ... Danilov, A. (2018). Comorbidities predict inferior outcomes in chronic lymphocytic leukemia treated with ibrutinib. Cancer, 124(15), 3192-3200. https://doi.org/10.1002/cncr.31554

Comorbidities predict inferior outcomes in chronic lymphocytic leukemia treated with ibrutinib. / Gordon, Max J.; Churnetski, Michael; Alqahtani, Hamood; Rivera, Xavier; Kittai, Adam; Amrock, Stephen M.; James, Spencer; Hoff, Sheila; Manda, Sudhir; Spurgeon, Stephen; Choi, Michael; Cohen, Jonathon B.; Persky, Daniel; Danilov, Alexey.

In: Cancer, Vol. 124, No. 15, 01.08.2018, p. 3192-3200.

Research output: Contribution to journalArticle

Gordon, MJ, Churnetski, M, Alqahtani, H, Rivera, X, Kittai, A, Amrock, SM, James, S, Hoff, S, Manda, S, Spurgeon, S, Choi, M, Cohen, JB, Persky, D & Danilov, A 2018, 'Comorbidities predict inferior outcomes in chronic lymphocytic leukemia treated with ibrutinib', Cancer, vol. 124, no. 15, pp. 3192-3200. https://doi.org/10.1002/cncr.31554
Gordon MJ, Churnetski M, Alqahtani H, Rivera X, Kittai A, Amrock SM et al. Comorbidities predict inferior outcomes in chronic lymphocytic leukemia treated with ibrutinib. Cancer. 2018 Aug 1;124(15):3192-3200. https://doi.org/10.1002/cncr.31554
Gordon, Max J. ; Churnetski, Michael ; Alqahtani, Hamood ; Rivera, Xavier ; Kittai, Adam ; Amrock, Stephen M. ; James, Spencer ; Hoff, Sheila ; Manda, Sudhir ; Spurgeon, Stephen ; Choi, Michael ; Cohen, Jonathon B. ; Persky, Daniel ; Danilov, Alexey. / Comorbidities predict inferior outcomes in chronic lymphocytic leukemia treated with ibrutinib. In: Cancer. 2018 ; Vol. 124, No. 15. pp. 3192-3200.
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abstract = "BACKGROUND: Most patients with chronic lymphocytic leukemia (CLL) present with multiple comorbidities. Although comorbidities negatively affect outcomes for patients treated with chemoimmunotherapy, their impact on patients who receive targeted therapies is unknown. METHODS: This multicenter, retrospective analysis evaluated the significance of comorbidities, as assessed by the Cumulative Illness Rating Scale (CIRS), among patients with CLL treated with ibrutinib. RESULTS: One hundred forty-five patients received ibrutinib (80{\%} in a relapsed/refractory setting). A high burden of comorbidities (CIRS score ≥ 7) was associated with inferior median event-free survival (EFS; 24 vs 37 months; P =.003) and 2-year overall survival (OS; 79{\%} vs 100{\%}; P =.005). In an adjusted Cox model, both EFS and OS worsened with an incremental increase in the CIRS score. Furthermore, comorbidities were associated with an increased risk of ibrutinib dose reduction and therapy discontinuation. CIRS was predictive in both frontline and relapsed CLL, regardless of patient age. CONCLUSIONS: Comorbidities portend a poor prognosis among patients with CLL treated with ibrutinib. Prospective studies are needed to optimize the treatment of patients with CLL who have comorbidities. Cancer 2018.",
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