Impact of comorbidities on overall survival in patients with chronic myeloid leukemia: results of the randomized CML study IV.
СтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Saussele Susanne, Krauss Marie-Paloma, Hehlmann Rüdiger, Lauseker Michael, Proetel Ulrike, Kalmanti Lida, Hanfstein Benjamin, Fabarius Alice, Kraemer Doris, Berdel Wolfgang E, Bentz Martin, Staib Peter, de Wit Maike, Wernli Martin, Zettl Florian, Hebart Holger F, Hahn Markus, Heymanns Jochen, Schmidt-Wolf Ingo, Schmitz Norbert, Eckart Michael J, Gassmann Winfried, Bartholomäus Andrea, Pezzutto Antonio, Leibundgut Elisabeth Oppliger, Heim Dominik, Krause Stefan W, Burchert Andreas, Hofmann Wolf-Karsten, Hasford Joerg, Hochhaus Andreas, Pfirrmann Markus, Müller Martin C, Schweizerische Arbeitsgemeinschaft für Klinische Krebsforschung and the German CML Study Group
Аннотация
We studied the influence of comorbidities on remission rate and overall survival (OS) in patients with chronic myeloid leukemia (CML). Participants of the CML Study IV, a randomized 5-arm trial designed to optimize imatinib therapy, were analyzed for comorbidities at diagnosis using the Charlson Comorbidity Index (CCI); 511 indexed comorbidities were reported in 1519 CML patients. Age was an additional risk factor in 863 patients. Resulting CCI scores were as follows: CCI 2, n = 589; CCI 3 or 4, n = 599; CCI 5 or 6, n = 229; and CCI ≥ 7, n = 102. No differences in cumulative incidences of accelerated phase, blast crisis, or remission rates were observed between patients in the different CCI groups. Higher CCI was significantly associated with lower OS probabilities. The 8-year OS probabilities were 93.6%, 89.4%, 77.6%, and 46.4% for patients with CCI 2, 3 to 4, 5 to 6, and ≥7, respectively. In multivariate analysis, CCI was the most powerful predictor of OS, which was still valid after removal of its age-related components. Comorbidities have no impact on treatment success but do have a negative effect on OS, indicating that survival of patients with CML is determined more by comorbidities than by CML itself. OS may therefore be inappropriate as an outcome measure for specific CML treatments. The trial was registered at www.clinicaltrials.gov as #NCT00055874.