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

Wei XU; Shu Hua YI; Ru Feng; Xin Wang; Jie Jin; Jian Qing MI; Kai Yang Ding; Wei Yang; Ting Niu; Shao Yuan Wang; Ke Shu Zhou; Hong Ling Peng; Liang Huang; Li Hong Liu; Jun MA; Jun Luo; Li Ping SU; Ou Bai; Lin Liu; Fei LI; Peng Cheng HE; Yun Zeng; Da Gao; Ming Jiang; Ji Shi Wang; Hong Xia Yao; Lu Gui Qiu; Jian Yong LI

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

Author: Wei XU ¹ ; Shu Hua YI ² ; Ru FENG ³ ; Xin WANG ⁴ ; Jie JIN ⁵ ; Jian Qing MI ⁶ ; Kai Yang DING ⁷ ; Wei YANG ⁸ ; Ting NIU ⁹ ; Shao Yuan WANG ¹⁰ ; Ke Shu ZHOU ¹¹ ; Hong Ling PENG ¹² ; Liang HUANG ¹³ ; Li Hong LIU ¹⁴ ; Jun MA ¹⁵ ; Jun LUO ¹⁶ ; Li Ping SU ¹⁷ ; Ou BAI ¹⁸ ; Lin LIU ¹⁹ ; Fei LI ²⁰ ; Peng Cheng HE ²¹ ; Yun ZENG ²² ; Da GAO ²³ ; Ming JIANG ²⁴ ; Ji Shi WANG ²⁵ ; Hong Xia YAO ²⁶ ; Lu Gui QIU ² ; Jian Yong LI ¹
Author Information

1. Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China.
2. 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.
3. Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
4. Shandong Provincial Hospital, Jinan 250021, China.
5. The First Affiliated Hospital of Medical College of Zhejiang University, Hangzhou 310003, China.
6. Ruijin Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai 200025, China.
7. Anhui Province Cancer Hospital, Hefei 230031, China.
8. Shengjing Hospital Affiliated to China Medical University, Shenyang 117004, China.
9. West China Hospital of Sichuan University, Chengdu 610044, China.
10. Union Hospital Affiliated to Fujian Medical University, Fuzhou 350001, China.
11. Henan Cancer Hospital (Affiliated Cancer Hospital of Zhengzhou University), Zhengzhou 450003, China.
12. Xiangya Second Hospital of Central South University, Changsha 410008, China.
13. Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
14. The Fourth Hospital of Hebei Medical University (Hebei Tumor Hospital), Shijiazhuang 050011, China.
15. Harbin Institute of hematological oncology, Harbin 150001, China.
16. The First Affiliated Hospital of Guangxi Medical University, Nanchang 530021, China.
17. Shanxi Cancer Hospital, Taiyuan 030013, China.
18. The first hospital of Jilin University, Changchun 130061, China.
19. The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China.
20. The First Affiliated Hospital of Nanchang University, Nanchang 330006, China.
21. The First Affiliated Hospital of Xi' an Jiaotong University, Xi' an 710061, China.
22. The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China.
23. Affiliated Hospital of Inner Mongolia Medical University, Hohhot 750306, China.
24. The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China.
25. Affiliated hospital of Guizhou Medical University, Guiyang 550004, China.
26. Hainan Provincial People's Hospital, Haikou 570311, China.
Publication Type:Journal Article
Keywords: Chronic lymphocytic leukemia; Diagnosis; Survey research; Therapeutic
MeSH: Female; Humans; Male; Aged; Middle Aged; Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy*; Prognosis; Lymphoma, B-Cell; Immunohistochemistry; Immunoglobulin Heavy Chains/therapeutic use*
From: Chinese Journal of Hematology 2023;44(5):380-387
CountryChina
Language:Chinese
Abstract: 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.