CIRS-G score as a rapid way to determine the overall multimorbidity burden and to select optimal and individualized therapy in newly diagnosed eldery CLL patients
Journal
Македонски медицински преглед = Macedonian Medical Review
Date Issued
2020
Author(s)
Slobodanka Trpkovska Terzieva
Dijana Milovska
Bozidar Kocoski
Milce Cvetanoski
Aleksandar Stojanovic
Abstract
Introduction. Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the elderly population. Many of these patients have multiple comorbidities, which might influence the choice of an adequate upfront chemoimmunotherapy option. The Cumulative
Illness Rating Scale for Geriatrics (CIRS-G) score seems to be a reliable tool for assessment of the
burden of comorbidity in elderly cancer patients.
Objectives. The primary objective of our study was to assess the distribution of CIRS score status in CLL patients in real clinical practice. The secondary objective was to analyze which treatment option was used, and the effects it produced in each patients’ group, classified according to the CIRS score.
Methods. In our prospective, single-center study, we focused on CLL patients that were referred to the University Clinic for Hematology in Skopje between 2017 and 2019. Comorbidity was assessed by the CIRS-G score in all patients included in our study (n=56) prior to the process of deciding on the most adequate treatment option. Results. The median age was 69 (±9.4) years. Comorbidities were identified in 80.4% of the study population, with an average CIRS score of 3.9. The three most common comorbidities were related to involvement of the vascular system (41.1%), endocrine-metabolic disorders (32.1%), and respiratory system disorders (17.9%). Only 16.1% of the patients had only 1 affected organ
or system, other than hematological issues, while 64% of the patients had ≥2 affected systems. In 33.9% of the study patient cohort, the watch and wait initial approach was the standard of care. We considered 66.1% of patients to be requiring treatment, as follows: chemotherapy (chlorambucil, fludarabine+cyclophosphamide, bendamustine) only (30.4%), rituximab-based
therapy (33.9%), and 1.8% of patients, due to the high comorbidity burden, were eligible only for supportive care. There was a stable trend of correlation between the CIRS score assessment and the treatment option prescribed (rs=0.7188, p<0.000001).
Conclusions. The comorbidity status is a major consideration when treating elderly patients with CLL. Our study shows that comorbidity is quite a common feature in CLL patients and that it is increasing with age. CIRS is helpful in identifying the best treatment combination for the patients, that will enhance achieving long-term control of CLL, maintaining an optimal quality of life level.
Illness Rating Scale for Geriatrics (CIRS-G) score seems to be a reliable tool for assessment of the
burden of comorbidity in elderly cancer patients.
Objectives. The primary objective of our study was to assess the distribution of CIRS score status in CLL patients in real clinical practice. The secondary objective was to analyze which treatment option was used, and the effects it produced in each patients’ group, classified according to the CIRS score.
Methods. In our prospective, single-center study, we focused on CLL patients that were referred to the University Clinic for Hematology in Skopje between 2017 and 2019. Comorbidity was assessed by the CIRS-G score in all patients included in our study (n=56) prior to the process of deciding on the most adequate treatment option. Results. The median age was 69 (±9.4) years. Comorbidities were identified in 80.4% of the study population, with an average CIRS score of 3.9. The three most common comorbidities were related to involvement of the vascular system (41.1%), endocrine-metabolic disorders (32.1%), and respiratory system disorders (17.9%). Only 16.1% of the patients had only 1 affected organ
or system, other than hematological issues, while 64% of the patients had ≥2 affected systems. In 33.9% of the study patient cohort, the watch and wait initial approach was the standard of care. We considered 66.1% of patients to be requiring treatment, as follows: chemotherapy (chlorambucil, fludarabine+cyclophosphamide, bendamustine) only (30.4%), rituximab-based
therapy (33.9%), and 1.8% of patients, due to the high comorbidity burden, were eligible only for supportive care. There was a stable trend of correlation between the CIRS score assessment and the treatment option prescribed (rs=0.7188, p<0.000001).
Conclusions. The comorbidity status is a major consideration when treating elderly patients with CLL. Our study shows that comorbidity is quite a common feature in CLL patients and that it is increasing with age. CIRS is helpful in identifying the best treatment combination for the patients, that will enhance achieving long-term control of CLL, maintaining an optimal quality of life level.
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