PB1913 CIRS SCORE AS A RELIABLE COMORBIDITY EVALUATION TOOL MAY INFLUENCE THERAPEUTIC DECISIONS IN ELDERLY CLL PATIENTS
Authors: Amzai G. , Karanfilski O. , Genadieva Stavric S. , Sotirova T. , Trpkovska Terzieva S. , Pavkovic M. , Milovska D. , Muca A. , Kocovski B. , Stojanovic A. 
Published: June 2019

Background:

Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the elderly population and many of these patients have multiple comorbidities, which might limit the eligibility for upfront chemoimmunotherapy options. The Cumulative Illness Rating Scale (CIRS) score seems to be a reliable tool for assessment of the burden of comorbidity in elderly cancer patients. It may identify fit and unfit CLL patients and influence the therapeutic decision‐making process.

Aims:

The primary objective of our study was to assess the CIRS score status in CLL patients in real clinical practice. The secondary objective was to analyze which treatment option was used in each patient's group, classified according to CIRS.

Methods:

In our prospective, single‐center study we focused on CLL patients that visited the University clinic for hematology in Skopje between March 20th 2017 and January 22nd 2019. Comorbidity was assessed by the CIRS‐G score in all patients included in our study (n = 56) prior to reaching a multidisciplinary treatment decision.

Results:

In our series, 56 CLL patients; 30 (53.6%) males and 26 (46.4%) females, were included. Median age was 69 (± 9.4) years (range 38‐85). Comorbidities were identified in 80.4% of the study population, with an average CIRS score of 3.9 (range 0‐13). Only 19.6% of the patients were comorbidity free. There was a positive correlation between the CIRS score and the age (rs = 0.2276, p = 0.04). Two thirds, or 67.9% of the patients had a CIRS score <6, 21.4% had CIRS score between 6 and12 and CIRS score was >12 in only 8.9% of patients. The three most common comorbidities were related to affections 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 approach was the standard of care; 66.1% of patients were eligible for 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, received only supportive care. There was a stable trend of correspondence between the CIRS score assessment and the treatment option prescribed (rs = 0.7188, p < 0.000001). Despite their eligibility for novel therapies (e.g. obinutuzumab, ibrutinib, idelalisib etc.) none of the patients received them due to their local unavailability.

Summary/Conclusion:

Our study shows that comorbidity is a very common feature in CLL patients and that it is increasing with age. Despite the fact that 8 out of 10 patients had at least one affected organ/system, the general comorbidity burden was low. 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.