Significance of comorbidity for patients with chronic lymphocytic leukemia

Background. Chronic lymphocytic leukemia (CLL) remains an uncurable disease, in which the age, number and severity of comorbidities primarily determine the choice of therapeutic tactics and objectives. Aim. To evaluate actual comorbidity and polymorbidity in patients with CLL and a possible relationship between the diseases and comorbidities that are considered concurrent and side effects of the administered treatment. Materials and methods. The study consisted of two parts. In a retrospective study, we analyzed records of patients with CLL from the Registry for Diagnostics and Treatment of Lymphoproliferative Diseases. In addition, we thoroughly evaluated and prospectively followed up 124 patients in the course of their preparation to a new stage of CLL tratement. Results. Examining data from the Russian Registry for Diagnostics and Treatment of Lymphoproliferative Diseases (n=1361) showed that in Russia, the age of patients with newly diagnosed CLL has increased in the recent decade with the increase in life span, which might change the comorbidity structure. Comparing retrospective and our own data (n=124) showed that diagnoses of concurrent diseases are often recorded formally (p<0.0001). This suggests a need for thorough evaluation of CLL patients by therapists and cardiologists. In this study, where the cardiological and therapeutic status of CLL patients was assessed adequately, the computed Charlson index and the trans-nosological comorbidity index determined the cumulative survival of CLL patients; the presence of three or more concurrent diseases and/or Charlson index >3 suggested a poor prognosis for patients with CLL. Conclusion. Diagnosis and treatment of comorbidities in patients with CLL require participation of different medical specialists working in a close contact with oncohematologists.

коморбидность, полиморбидность, хронический лимфолейкоз, ретроспективное исследование, собственное исследование, comorbidity, polymorbidity, chronic lymphocytic leukemia, retrospective study, own study

1. Gribben J.G. Chronic lymphocytic leukemia: planning for an aging population. Expert Review of Anticancer Therapy. 2010;10 (9):1389-94. DOI: 10.1586/era. 10.127

2. Abrisqueta P., Pereira A., Rozman C., Aymerich M., Gine E., Moreno C. et al. Improving survival in patients with chronic lymphocytic leukemia (1980-2008): the Hospital Clinic of Barcelona experience. Blood. 2009; 114 ( 10) :2044-50. DOI: 10.1182/blood-2009-04-214346

3. Merli F., Mammi C., Ilariucci F. Integrating Oncogeriatric Tools into the Management of Chronic Lymphocytic Leukemia: Current State of the Art and Challenges for the Future. Current Oncology Reports [Internet]. 2015 [cited 2018];17 (7). D0I:10.1007/s11912-015-0454-0

4. Thurmes P., Call T., Slager S., Zent C., Jenkins G., Schwager S. et al. Comorbid conditions and survival in unselected, newly diagnosed patients with chronic lymphocytic leukemia. Leukemia & Lymphoma. 2008;49 (1):49-56. DOI:10.1080/10428190701724785

5. Del Giudice I., Mauro FR, Foà R. Chronic lymphocytic leukemia in less fit patients: «slow-go.» Leukemia & Lymphoma. 2011;52 (12):2207-16. DOI:10.3109/10428194.2011.606386

6. Стругов В. В., Стадник Е. А., Вирц Ю. В., Силина Т. О., Зарицкий А. Ю. Значение возраста и сопутствующих заболеваний в терапии хронического лимфолейкоза. Клиническая онкогематология. Фундаментальные исследования и клиническая практика. 2016;9 (2):162-75. DOI:10.21320/250 0-2139-2016-9-2-162-175

7. Goede V., Cramer P., Busch R., Bergmann M., Stauch M., Hopfinger G. et al. Interactions between comorbidity and treatment of chronic lymphocytic leukemia: results of German Chronic Lymphocytic Leukemia Study Group trials. Haematologica. 2014;99 (6):1095-100. DOI: 10.3324/haematol. 2013.096792

8. Арьев А. Л., Овсянникова Н. А., Арьева Г. Т., Дзахова С. Д., Хавинсон В. Х. Полиморбидность в гериатрии. Практическая онкология. 2015;16 (3):83-90.

9. Николаев Ю. А., Митрофанов И. М., Поспелова Т. И., Долгова Н. А., Поляков В. Я. Особенности полиморбидности в современной клинике внутренних болезней. Бюллетень сибирского отделения российской академии медицинских наук. 2014;34 (2):44-9.

10. Zamorano JL, Lancellotti P., Rodriguez Munoz D., Aboyans V., Asteggiano R., Galderisi M. et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). European Heart Journal. 2016;37 (36):2768-801. DOI:10.1093/eurheartj/ehw211

11. Kang HJ, Park JS, Kim D-W, Lee J., Jeong YJ, Choi SM et al. Adverse pulmonary reactions associated with the use of monoclonal antibodies in cancer patients. Respiratory Medicine. 2012;106 (3):443-50. DOI:10.1016/j. rmed. 2011.11.009

12. Franzen D., Ciurea A., Bratton DJ, Clarenbach CF, Latshang TD, Russi EW et al. Effect of rituximab on pulmonary function in patients with rheumatoid arthritis. Pulmonary Pharmacology & Therapeutics. 2016;37:24-9. DOI:10.1016/j. pupt. 2016.02.002

13. Arulkumaran N., Suleman R., Cecconi M., Kiely P., Chua F. Rituximab Associated Pneumonitis in Antineutrophil Cytoplasmic Antibody -Associated Vasculitis: Journal of Clinical Rheumatology. 2012;18 (1):39-41. DOI:10.1097/RHU. 0b013e31823ee5bf

14. Faillace C., Carvalho JF de. Antiphospholipid syndrome development after rituximab treatment. Joint Bone Spine. 2012;79 (2):200-1. DOI:10.1016/j. jbspin. 2011.07.001

15. Floyd JD, Nguyen DT, Lobins RL, Bashir Q., Doll DC, Perry M.C. Cardiotoxicity of Cancer Therapy. Journal of Clinical Oncology. 2005;23 (30):7685-96. DOI:10.1200/JCO. 2005.08.789

16. Sharif K., Watad A., Bragazzi NL, Asher E., Abu Much A., Horowitz Y. et al. Anterior ST-elevation myocardial infarction induced by rituximab infusion: A case report and review of the literature. Journal of Clinical Pharmacy and Therapeutics. 2017;42 (3):356-62. DOI:10.1111 /jcpt. 12522

17. Поддубная И. В., Савченко В. Г., Абдурахманов Д. Т., Абузарова Г. Р., Аль-Ради Л. С., Бабичева Л. Г. et al. Российские клинические рекомендации по диагностике и лечению лимфопролиферативных заболеваний. 2016;1-324.

18. Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2014;130 (19):1749-67. DOI:10.1161/CIR. 0000000000000095