文章：

美国慢性淋巴细胞白血病/小淋巴细胞淋巴瘤患者真实世界治疗序列相关的总生存期分析

Overall Survival Associated with Real-World Treatment Sequences in Patients with CLL/SLL in the United States

原文发布日期：7 August 2025

DOI: 10.3390/cancers17152592

类型: Article

开放获取: 是

英文摘要：

Background/Objectives:This study compared overall survival (OS) associated with common real-world treatment sequences in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) in the United States.Methods: Utilizing the nationwide Flatiron Health electronic health record-derived de-identified database, adult CLL/SLL patients who initiated systemic therapy (JAN2016-NOV2023) and received at least two lines of therapy (LoTs) were analyzed. Treatment regimens were categorized based on drug class, and most frequent (n ≥ 50) sequences (first LoT followed by [→] second LoT) were compared. OS from initiation of the first LoT was compared using multivariable Cox proportional hazard models, and adjusted hazard ratios with 95% CIs were reported.Results: Among 2354 eligible patients, n = 1711 (73%) received the 16 most frequent treatment sequences. Sequencing chemoimmunotherapy (CIT) → CIT (HR: 2.29 [1.23–4.28]), anti-CD20 monoclonal antibody (anti-CD20mab) monotherapy → CIT (1.95 [1.03–3.69]), and covalent Bruton tyrosine kinase inhibitor (cBTKi) monotherapy → anti-CD20mab monotherapy (2.00 [1.07–3.74]) were associated with worse OS compared to patients treated with cBTKi monotherapy → B-cell lymphoma 2 inhibitors (BCL2i) + anti-CD20mab (reference).Conclusions: OS associated with other sequences were not significantly different from the reference sequence in adjusted analyses, suggesting a lack of evidence for the optimal standard of care for sequencing the first two LoTs in real-world settings. Future research should reassess sequencing outcomes as novel treatments become adopted into clinical practice.

摘要翻译： 

背景/目的：本研究比较了美国慢性淋巴细胞白血病/小淋巴细胞淋巴瘤（CLL/SLL）患者中常见真实世界治疗序列相关的总生存期（OS）。方法：利用全国性Flatiron Health电子健康记录去标识化数据库，对2016年1月至2023年11月期间开始系统性治疗且至少接受过两线治疗（LoTs）的成年CLL/SLL患者进行分析。治疗方案根据药物类别进行分类，并对最常见（n≥50）的治疗序列（一线治疗接续[→]二线治疗）进行比较。采用多变量Cox比例风险模型比较从一线治疗开始的总生存期，并报告调整后的风险比及95%置信区间。结果：在2354例符合条件患者中，1711例（73%）接受了16种最常见的治疗序列。与接受共价布鲁顿酪氨酸激酶抑制剂（cBTKi）单药治疗→B细胞淋巴瘤2抑制剂（BCL2i）+抗CD20单克隆抗体联合治疗（参照组）的患者相比，化疗免疫治疗（CIT）序贯CIT（HR：2.29 [1.23–4.28]）、抗CD20单抗单药治疗序贯CIT（1.95 [1.03–3.69]）以及cBTKi单药治疗序贯抗CD20单抗单药治疗（2.00 [1.07–3.74]）与较差的OS相关。结论：在调整分析中，其他治疗序列的OS与参照序列无显著差异，这表明在真实世界环境中，对于前两线治疗的最佳标准顺序缺乏证据支持。随着新型治疗手段在临床实践中的应用，未来研究应重新评估治疗序列的临床结局。

原文链接：

Overall Survival Associated with Real-World Treatment Sequences in Patients with CLL/SLL in the United States