摘要
目的了解慢性淋巴细胞白血病(CLL)/小淋巴细胞淋巴瘤(SLL)在中国各级医疗机构血液科、肿瘤科与淋巴瘤科的诊疗现状。方法2021年3月至2021年7月期间国内多家医疗单位开展了一项多中心问卷调查,共纳入1000名符合研究条件的医生,采用面对面和线上问卷调查相结合的方式,利用标准化问卷对其所诊疗的CLL/SLL患者的疾病诊断、预后评估、治疗方案选择、布鲁顿酪氨酸激酶(BTK)抑制剂使用等方面进行调查。结果①受访医生接诊的CLL/SLL患者男性比例高于女性(62.0%对38.0%),年龄主要集中在61~70岁(占37.7%);②在患者诊断上,除血常规外,受访医生大多进行了骨髓穿刺涂片、活检、免疫组化等检测;③仅13.7%的受访医生完全掌握了现有指南推荐的起始治疗指征;④在预后高危因素认知方面,受访医生对伴免疫球蛋白重链可变区(IGHV)未突变、11q-的掌握远不如TP53突变和复杂核型这两个预后高危因素,且仅有17.1%的受访医生完全掌握了CLL国际预后指数(CLL-IPI)评分系统;⑤在一线治疗方案中,BTK抑制剂是不同类型患者的一线治疗方案,且医生对伴高危因素和老年患者需优先使用BTK抑制剂已形成一定认知,但不同类型患者实际使用BTK抑制剂比例不高(31.6%~46.0%);⑥69.0%的受访医生曾减量使用过BTK抑制剂,66.8%的医生曾中断BTK抑制剂超过12 d。导致减量或中断BTK抑制剂使用的主要原因为不良反应(房颤、重度骨髓抑制、出血、肺部感染等)、经济因素以及病情得到控制;⑦血液科医生和肿瘤科医生在CLL/SLL预后评估、治疗方案选择、BTK抑制剂应用等方面均存在一定差异。结论目前中国各级医院血液科、肿瘤科与淋巴瘤科医生在CLL/SLL的诊断、治疗指征判定、预后评估、伴随疾病评估、治疗方案选择以及BTK抑制剂使用上仍有很多不足,由不良反应导致减量或中断/终止治疗的患者占比较高。
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.Results①The 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.
作者
徐卫
易树华
冯茹
王欣
金洁
糜坚青
丁凯阳
杨威
牛挺
王少元
周可树
彭宏凌
黄亮
刘丽宏
马军
罗军
苏丽萍
白鸥
刘林
李菲
贺鹏程
曾云
高大
江明
王季石
姚红霞
邱录贵
李建勇
Xu Wei;Yi Shuhua;Feng Ru;Wang Xin;Jin Jie;Mi Jianqing;Ding Kaiyang;Yang Wei;Niu Ting;Wang Shaoyuan;Zhou Keshu;Peng Hongling;Huang Liang;Liu Lihong;Ma Jun;Luo Jun;SuLiping;Bai Ou;Liu Lin;Li Fei;He Pengcheng;Zeng Yun;Gao Da;Jiang Ming;Wang Jishi;YaoHongxia;Qiu Lugui;Li Jianyong(Department of Hematology,the First Affiliated Hospital of Nanjing Medical University,Jiangsu Province Hospital,Nanjing 210029,China;State Key Laboratory of Experimental Hematology,National Clinical Research Center for Blood Diseases,Haihe Laboratory of Cell Ecosystem,Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Tianjin 300020,China;Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Shandong Provincial Hospital,Jinan 250021,China;The First Affiliated Hospital of Medical College of Zhejiang University,Hangzhou 310003,China;Ruijin Hospital Affiliated to Medical College of Shanghai Jiaotong University,Shanghai 200025,China;Anhui Province Cancer Hospital,Hefei 230031,China;Shengjing Hospital Affiliated to China Medical University,Shenyang 117004,China;West China Hospital of Sichuan University,Chengdu 610044,China;Union Hospital Affiliated to Fujian Medical University,Fuzhou 350001,China;Henan Cancer Hospital(Affiliated Cancer Hospital of Zhengzhou University),Zhengzhou 450003,China;Xiangya Second Hospital of Central South University,Changsha 410008,China;Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;The Fourth Hospital of Hebei Medical University(Hebei Tumor Hospital),Shijiazhuang 050011,China;Harbin Institute of hematological oncology,Harbin 150001,China;The First Affiliated Hospital of Guangxi Medical University,Nanchang 530021,China;Shanxi Cancer Hospital,Taiyuan 030013,China;The first hospital of Jilin University,Changchun 130061,China;The First Affiliated Hospital of Chongqing Medical University,Chongqing 400042,China;The First Affiliated Hospital of Nanchang University,Nanchang 330006,China;The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;The First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Affiliated Hospital of Inner Mongolia Medical University,Hohhot 750306,China;The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China;Affiliated hospital of Guizhou Medical University,Guiyang 550004,China;Hainan Provincial People's Hospital,Haikou 570311,China)
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2023年第5期380-387,共8页
Chinese Journal of Hematology
基金
北京白求恩公益基金会。
