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v中国慢性淋巴细胞白血病/小淋巴细胞淋巴瘤诊疗现状:一项多中心问卷调查研究

Current status of diagnosis and treatment of chronic lymphocytic leukemia in China: A national multicenter survey research

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收录情况: ◇ 统计源期刊 ◇ 北大核心 ◇ CSCD-C ◇ 卓越:梯队期刊 ◇ 中华系列

机构: [1]江苏省人民医院(南京医科大学第一附属医院),南京 210029 [2]中国医学科学院血液 病医院(中国医学科学院血液学研究所),实验血液学国家重点实验室,国家血液系统疾 病临床医学研究中心,细胞生态海河实验室,天津 300020 [3]南方医科大学南方医院,广 州510515 [4]山东省立医院,济南 250021 [5]浙江大学医学院附属第一医院,杭州 310003 [6]上海交通大学医学院附属瑞金医院,上海 200025 [7]中国科学技术大学附属第 一医院,合肥 230031 [8]中国医科大学附属盛京医院,沈阳 117004 [9]四川大学华西医 院,成都邢610044 [10]福建医科大学附属协和医院,福州 [11]河南省肿瘤医院(郑 州大学附属肿瘤医院),郑州 450003 [12]中南大学湘雅二医院,长沙410008 [13]华中科 技大学同济医学院附属同济医院,武汉4430030 [14]河北医科大学第四医院(河北省肿瘤 医院),石家庄050011 [15]哈尔滨血液肿瘤研究所,哈尔滨实150001 [16]广西医科大学第 一附属医院,南宁 530021 [17]山西省肿瘤医院,太原030013 [18]吉林大学第一医院,长 春1130061 [19]重庆医科大学附属第一医院,重庆 400042 [20]南昌大学第一附属医院,南 昌 330006 [21]西安交通大学第一附属医院,西安 710061 [22]昆明医科大学第一附属医 院,昆明月650032 [23]内蒙古医科大学附属医院,呼和浩特 750306 [24]新疆医科大学第一 附属医院,乌鲁木齐 830011 [25]贵州医科大学附属医院,贵阳 550004 [26]海南省人民医 院,海口 570311
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关键词: 慢性淋巴细胞白血病: 问卷调查研究:诊断:治疗

摘要:
Objective: To understand the current status of diagnosis and treatment of chronic lymphocytic leukemia (CLL) /small lymphocytic lymphoma (SLL) among hematologists, oncologists, and lymphoma physicians from hospitals of different levels in China. Methods: This multicenter questionnaire survey was conducted from March 2021 to July 2021 and included 1,000 eligible physicians. A combination of face-to-face interviews and online questionnaire surveys was used. A standardized questionnaire regarding the composition of patients treated for CLL/SLL, disease diagnosis and prognosis evaluation, concomitant diseases, organ function evaluation, treatment selection, and Bruton tyrosine kinase (BTK) inhibitor was used. Results: ①The interviewed physicians stated that the proportion of male patients treated for CLL/SLL is higher than that of females, and the age is mainly concentrated in 61-70 years old. ②Most of the interviewed physicians conducted tests, such as bone marrow biopsies and immunohistochemistry, for patient diagnosis, in addition to the blood test. ③Only 13.7% of the interviewed physicians fully grasped the initial treatment indications recommended by the existing guidelines. ④In terms of cognition of high-risk prognostic factors, physicians' knowledge of unmutated immunoglobulin heavy-chain variable and 11q- is far inferior to that of TP53 mutation and complex karyotype, which are two high-risk prognostic factors, and only 17.1% of the interviewed physicians fully mastered CLL International Prognostic Index scoring system. ⑤Among the first-line treatment strategy, BTK inhibitors are used for different types of patients, and physicians have formed a certain understanding that BTK inhibitors should be preferentially used in patients with high-risk factors and elderly patients, but the actual use of BTK inhibitors in different types of patients is not high (31.6%-46.0%). ⑥BTK inhibitors at a reduced dose in actual clinical treatment were used by 69.0% of the physicians, and 66.8% of the physicians had interrupted the BTK inhibitor for >12 days in actual clinical treatment. The use of BTK inhibitors is reduced or interrupted mainly because of adverse reactions, such as atrial fibrillation, severe bone marrow suppression, hemorrhage, and pulmonary infection, as well as patients' payment capacity and effective disease progression control. ⑦Some differences were found in the perceptions and behaviors of hematologists and oncologists regarding the prognostic assessment of CLL/SLL, the choice of treatment options, the clinical use of BTK inhibitors, etc. Conclusion: At present, a gap remains between the diagnosis and treatment of CLL/SLL among Chinese physicians compared with the recommendations in the guidelines regarding the diagnostic criteria, treatment indications, prognosis assessment, accompanying disease assessment, treatment strategy selection, and rational BTK inhibitor use, especially the proportion of dose reduction or BTK inhibitor discontinuation due to high adverse events.

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第一作者机构: [1]江苏省人民医院(南京医科大学第一附属医院),南京 210029
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