Kliniğimizde tanı koyulan ve takip edilen kronik lenfositer lösemi tanılı hastaların güncel kılavuzlar eşliğinde epidemiyolojik verilerinin ve sağkalımlarının geriye dönük olarak incelenmesi
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Tarih
2022
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Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmamızda Trakya Üniversitesi Tıp Fakültesi Hematoloji Kliniği’nde 2000-2021 yılları arasında takipli edilen 301 KLL hastasının epidemiyolojik ve klinik verilerinin, sitogenetik çalışmalarının sağkalıma etkilerini; standart ve yeni nesil tedavi ajanlarını karşılaştırmayı ve literatüre katkıda bulunmayı amaçladık. Bu uğurda hastalar yaş, cinsiyet, tanı yaşı, Rai ve Binet evrelemesi, CIRS skorlaması, Charlson skorlaması, sitogenetik çalışmalar, verilen tedavi sayısı, genel sağkalım, sekonder malignite gibi parametreler ile değerlendirmeye alınmıştır. Çalışmamız sonucu 181 (%60,1) erkek, 120 (%39,9) kadın olarak izlenmiştir. Hastaların medyan tanı yaşı ise 66,00 (56,00-73,00) olarak bulunmuştur. Çalışmada komorbidite skorlaması olarak CIRS ve Charlson kullanılmıştır. CIRS skoru 8,00 (5,0012,50) ve Charlson skoru 3,00 (2,00-5,00) olarak hesaplanmıştır. Rai evresi arttıkça CIRS skorunun arttığı gözlenmiştir (p<0,001). Binet evrelemesinde ise hem CIRS skoru hem de Charlson skoru evre C hastalarda diğer evrelere göre anlamlı olarak yüksek saptanmıştır (p<0,001). Çalışmamızda 108 hasta tedavisiz olarak izleme alınmışken, 151 hastaya çeşitli tedaviler verilmiştir. Tedavi verilen 151 hastada tanıdan tedaviye kadar geçen medyan süre 9,5 ay olarak hesaplanmıştır. Ek olarak hastaların Rai ve Binet evreleri arttıkça tedaviye kadar geçen sürenin kısaldığı bulunmuştur (sırasıyla p<0,001; p:<0,001). Bu 151 hastaya birinci sıra tedavisi olarak standart tedavi uygulanmış olup 63 hasta remisyona girmişken, 88 hasta refrakter olarak değerlendirilerek ikinci sıra tedavi planlanmasına alınmıştır. Bu 88 refrakter hastaya 2. Sıra tedavi verilmiştir. Bu gruptaki 75 hastaya standart tedavi verilmişken 13 hastaya da yeni nesil tedavi uygulanmıştır. Tedavi sonrasında hastaların 40’ında remisyon izlenmişken, 48’i refrakter saptanmıştır. Üçüncü sıra olarak bu grubun 31’ine standart tedavi; 17’sine yeni nesil tedavi uygulanmıştır. Tedavi sonrasında hastaların 24’ü remisyonda 24’ü refrakter olarak değerlendirilmiştir. 301 hastanın medyan genel sağkalım süresi 100,0 ay, 5 yıllık kümülatif genel sağkalım oranı %64, 10 yıllık kümülatif genel sağkalım oranı %37 saptanmıştır. Genel sağkalıma etki eden paramatreler sırasıyla tek değişkenli analiz ve çok değişkenli analiz ile incelendiğinde CIRS skorunda 1 birim artışı ölüm riskini 1,262 kat; Binet evre C, evre A’ya göre ölüm riskini 2,954 kat; sitogenetik test sonucunda kötü prognozlu anomali varlığı iyi prognozlu anomali varlığına göre 2,94 kat, anomali izlenmeme durumuna göre de 2,58 kat ölüm riskini arttırdığı saptanmıştır. Tedavi alan 151 hastanın 5 yıllık kümülatif sağkalım %62, 10 yıllık kümülatif sağkalım %27 olarak hesaplanmıştır. Bu grupta standart tedavi alan hastalarda medyan sağkalım 80,0 ay iken yeni kuşak tedavi alan grupta 120,0 ay olarak hesaplanmıştır. 151 hastalık tedavi alan grup sırasıyla sağkalım ve mortalite analizlerinde sırasıyla tek değişkenli ve çok değişkenli regresyon analizi ile değerlendirildiğinde CIRS skorunda her bir birimlik artışın sağkalımı 1,274 kat; Binet evre C’nin evre A’ya göre sağkalımı 1,81 kat azalttığı hesaplanmıştır.
In our study, the effects of epidemiological and clinical data and cytogenetic studies on survival of 301 CLL patients followed in Trakya University Faculty of Medicine Hematology Clinic between 2000-2021; We aimed to compare standard and new generation treatment agents and contribute to the literature. For this purpose, patients were evaluated with parameters such as age, gender, age at diagnosis, Rai and Binet staging, CIRS scoring, Charlson scoring, cytogenetic studies, number of treatments given, overall survival, and secondary malignancy. As a result of our study, 181 (60.1%) men and 120 (39.9%) women were followed. The median age of diagnosis of the patients was 66.00 (56.00-73.00). CIRS and Charlson were used as comorbidity scoring in the study. The CIRS score was calculated as 8.00 (5.0012.50) and the Charlson score as 3.00 (2.00-5.00). It was observed that the CIRS score increased as the Rai stage increased (p<0.001). In Binet staging, both CIRS score and Charlson score were found to be significantly higher in stage C patients compared to other stages (p<0.001). In our study, 108 patients were followed up without treatment, while various treatments were given to 151 patients. The median time from diagnosis to treatment in 151 patients who received treatment was calculated as 9.5 months. In addition, it was found that as the Rai and Binet stages of the patients increased, the time to treatment was shortened (p<0.001; p:<0.001, respectively). Standard treatment was applied to these 151 patients as first-line treatment, and 63 patients were in remission, while 88 patients were evaluated as refractory and included in second-line treatment planning. These 88 refractory patients were given 2nd line treatment. While standard treatment was given to 75 patients in this group, new generation treatment was applied to 13 patients. After the treatment, remission was observed in 40 of the patients, while 48 of them were refractory. As the third line, standard treatment was given to 31 of this group; A new generation treatment was applied to 17 of them. After treatment, 24 of the patients were evaluated as in remission and 24 as refractory. The median overall survival of 301 patients was 100.0 months, the 5-year cumulative overall survival rate was 64%, and the 10-year cumulative overall survival rate was 37%. When the parameters affecting overall survival are examined by univariate analysis and multivariate analysis, respectively, 1 unit increase in the CIRS score increases the risk of death by 1.262 times; Binet stage C has 2,954 times the risk of death compared to stage A; As a result of cytogenetic test, it was determined that the presence of anomaly with bad prognosis increased the risk of death 2.94 times compared to the presence of anomaly with good prognosis and 2.58 times higher than the presence of no anomaly. The 5-year cumulative survival of 151 patients who received treatment was 62%, and the 10-year cumulative survival was 27%. While the median survival was 80.0 months in patients receiving standard treatment in this group, it was calculated as 120.0 months in the new generation treatment group. When the treatment group of 151 patients was evaluated with univariate and multivariate regression analysis in survival and mortality analyzes, respectively, each unit increase in the CIRS score had a survival rate of 1.274 times; Binet stage C was calculated to decrease survival 1.81 times compared to stage A.
In our study, the effects of epidemiological and clinical data and cytogenetic studies on survival of 301 CLL patients followed in Trakya University Faculty of Medicine Hematology Clinic between 2000-2021; We aimed to compare standard and new generation treatment agents and contribute to the literature. For this purpose, patients were evaluated with parameters such as age, gender, age at diagnosis, Rai and Binet staging, CIRS scoring, Charlson scoring, cytogenetic studies, number of treatments given, overall survival, and secondary malignancy. As a result of our study, 181 (60.1%) men and 120 (39.9%) women were followed. The median age of diagnosis of the patients was 66.00 (56.00-73.00). CIRS and Charlson were used as comorbidity scoring in the study. The CIRS score was calculated as 8.00 (5.0012.50) and the Charlson score as 3.00 (2.00-5.00). It was observed that the CIRS score increased as the Rai stage increased (p<0.001). In Binet staging, both CIRS score and Charlson score were found to be significantly higher in stage C patients compared to other stages (p<0.001). In our study, 108 patients were followed up without treatment, while various treatments were given to 151 patients. The median time from diagnosis to treatment in 151 patients who received treatment was calculated as 9.5 months. In addition, it was found that as the Rai and Binet stages of the patients increased, the time to treatment was shortened (p<0.001; p:<0.001, respectively). Standard treatment was applied to these 151 patients as first-line treatment, and 63 patients were in remission, while 88 patients were evaluated as refractory and included in second-line treatment planning. These 88 refractory patients were given 2nd line treatment. While standard treatment was given to 75 patients in this group, new generation treatment was applied to 13 patients. After the treatment, remission was observed in 40 of the patients, while 48 of them were refractory. As the third line, standard treatment was given to 31 of this group; A new generation treatment was applied to 17 of them. After treatment, 24 of the patients were evaluated as in remission and 24 as refractory. The median overall survival of 301 patients was 100.0 months, the 5-year cumulative overall survival rate was 64%, and the 10-year cumulative overall survival rate was 37%. When the parameters affecting overall survival are examined by univariate analysis and multivariate analysis, respectively, 1 unit increase in the CIRS score increases the risk of death by 1.262 times; Binet stage C has 2,954 times the risk of death compared to stage A; As a result of cytogenetic test, it was determined that the presence of anomaly with bad prognosis increased the risk of death 2.94 times compared to the presence of anomaly with good prognosis and 2.58 times higher than the presence of no anomaly. The 5-year cumulative survival of 151 patients who received treatment was 62%, and the 10-year cumulative survival was 27%. While the median survival was 80.0 months in patients receiving standard treatment in this group, it was calculated as 120.0 months in the new generation treatment group. When the treatment group of 151 patients was evaluated with univariate and multivariate regression analysis in survival and mortality analyzes, respectively, each unit increase in the CIRS score had a survival rate of 1.274 times; Binet stage C was calculated to decrease survival 1.81 times compared to stage A.
Açıklama
Anahtar Kelimeler
KLL, Genel sağkalım, Risk sınıflaması ve sitogenetik, CLL, Overall survival, Risk stratification and cytogenetics
