While having chronic lymphocytic leukemia (CLL) can feel like more than enough to deal with on its own, many patients also have other ongoing health conditions that need management. These additional conditions or diseases are referred to as comorbidities. Comorbidity means the presence of two or more diseases or conditions in a patient at the same time, such as having CLL and high blood pressure. Both are conditions that need ongoing treatment, and the conditions themselves or the medications used to treat them could potentially interact with each other.
Patients with comorbidities tend to not benefit as much from ibrutinib therapy because they tend to discontinue ibrutinib earlier, which can also result in their progression-free survival being shortened as well. Researchers are interested in learning if there are specific comorbidities that predict how well patients respond to ibrutinib treatment so that they can make better treatment decisions.
At the annual meeting of the American Society of Hematology (ASH) 2020, Steven Bloom, CLL Society’s Chairman of the Board and President, interviewed Dr. Alexey Danilov, Associate Director of the Toni Stephenson Lymphoma Center at City of Hope in Duarte, CA. They discussed the CLL Comorbidity Index (CLL-CI) for predicting survival and tolerance of ibrutinib.
- The current scoring system used to assess patient comorbidities (Cumulative Illness Rating Scale) incorporates information on 14 organ systems, which is cumbersome to do
- Danilov and his colleagues created a simplified scoring system (CLL-CI) that assesses 3 major groups of comorbidities:
- Endocrine: ie, diabetes, hypothyroidism, obesity
- Cardiovascular: ie, atherosclerosis, deep vein thrombosis
- Upper Gastrointestinal: ie, gastroesophageal reflux disease, peptic ulcer, taking a proton-pump inhibitor
- The researchers looked back at records from 339 CLL patients who had undergone treatment with ibrutinib to see if these groups of comorbidities were related to patient outcomes
- They found that patients with a higher CLL-CI score (meaning more comorbidities) were more likely to discontinue ibrutinib due to adverse events and were less likely to survive
- This new scoring system appears to predict inferior survival with ibrutinib treatment
- While CLL-CI is simpler to use, it still needs further validation prior to being used clinically
Having multiple conditions to manage can make medical treatment complicated. This research shows that certain comorbidities are associated with worse outcomes on ibrutinib, but it is also important to remember that these are only correlations. It is always important to talk with your doctor about your specific risks to make informed decisions that are in your best interests.
Please enjoy this interview with Dr. Danilov from the virtual ASH meeting which was held in December 2020.
The Chronic Lymphocytic Leukemia Comorbidity Index (CLL-CI) Predicts Survival and Tolerance of Ibrutinib Therapy in Patients with CLL: A Multicenter Retrospective Cohort Study
Take care of yourself first.
Ann Liu, PhD