title: Interactions between comorbidity and treatment of chronic lymphocytic leukemia: results of German Chronic Lymphocytic Leukemia Study Group trials.
abstract: This study investigated the impact of comorbidity in 555 patients with chronic lymphocytic leukemia enrolled in two trials of the German Chronic Lymphocytic Leukemia Study Group on first-line treatment with fludarabine plus cyclophosphamide, fludarabine, or chlorambucil. Patients with two or more comorbidities and patients with less than two comorbidities differed in overall survival (71.7 versus 90.2 months; P<0.001) and progression-free survival (21.0 versus 31.5 months; P<0.01). After adjustment for other prognostic factors and treatment, comorbidity maintained its independent prognostic value in a multivariate Cox regression analysis. Chronic lymphocytic leukemia was the major cause of death in patients with two or more comorbidities. Disease control in patients with two or more comorbidities was better with fludarabine plus cyclophosphamide than with fludarabine treatment, but not with fludarabine compared to chlorambucil treatment. These results give insight into interactions between comorbidity and therapy of chronic lymphocytic leukemia and suggest that durable control of the hematologic disease is most critical to improve overall outcome of patients with increased comorbidity. The registration numbers of the trials reported are NCT00276848 and NCT00262795.
authors.affiliation: Department I of Internal Medicine, Center of Integrated Oncology Cologne-Bonn, University of Cologne, Germany Department of Geriatric Medicine and Research, St. Marien Hospital and University of Cologne, Germany valentin.goede@uk-koeln.de.
authors.forename: Valentin
authors.initials: V
authors.lastname: Goede
authors.affiliation: Department I of Internal Medicine, Center of Integrated Oncology Cologne-Bonn, University of Cologne, Germany.
authors.forename: Paula
authors.initials: P
authors.lastname: Cramer
authors.affiliation: Institute of Medical Statistics and Epidemiology, Technical University of Munich, Germany.
authors.forename: Raymonde
authors.initials: R
authors.lastname: Busch
authors.affiliation: Department of Internal Medicine III, University of Ulm, Germany.
authors.forename: Manuela
authors.initials: M
authors.lastname: Bergmann
authors.affiliation: Private practice, Kronach, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Stauch
authors.affiliation: Medical Department III, Paracelsus Medical University Salzburg, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Hopfinger
authors.affiliation: Department of Internal Medicine III, University of Ulm, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Stilgenbauer
authors.affiliation: Department of Internal Medicine III, University of Ulm, Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Döhner
authors.affiliation: Department I of Internal Medicine, Center of Integrated Oncology Cologne-Bonn, University of Cologne, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Westermann
authors.affiliation: Department I of Internal Medicine, Center of Integrated Oncology Cologne-Bonn, University of Cologne, Germany Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Schwabing Hospital, Munich, Germany.
authors.forename: Clemens M
authors.initials: CM
authors.lastname: Wendtner
authors.affiliation: Department I of Internal Medicine, Center of Integrated Oncology Cologne-Bonn, University of Cologne, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Eichhorst
authors.affiliation: Department I of Internal Medicine, Center of Integrated Oncology Cologne-Bonn, University of Cologne, Germany Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases, University of Cologne, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hallek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome