Professor Jun Ma and his team from Harbin Institute of Hematology Oncology published in May 2023 in the Chinese Journal of Hematology titled "Current status of diagnosis and treatment of chronic lymphocytic leukemia in China: A national multicenter survey research", introducing the diagnosis, prognosis assessment, treatment plan selection, and the use of Bruton's tyrosine kinase (BTK) inhibitors for CLL/SLL in the hematology, oncology, and lymphoma departments of various levels of medical institutions in China. This study serves as a foundation for further advancing the standardized diagnosis and treatment of CLL/SLL.
Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are mature lymphocyte clonal proliferative tumors that primarily occurs in the middle-aged and elderly population and exhibits specific immunophenotypic characteristics. It is characterized by the abnormal proliferation of B lymphocytes in peripheral blood, bone marrow, spleen, and lymph nodes. With the accelerated aging process in our country, the incidence of CLL/SLL continues to rise, posing challenges to the diagnosis and treatment of patients with CLL/SLL.
This study conducted a multicenter questionnaire survey from March 2021 to July 2021. A total of 1,000 doctors meeting the study criteria from 647 hospitals across 30 provinces nationwide were included. The survey utilized a combination of face-to-face and online questionnaires, employing standardized questions to investigate aspects such as disease diagnosis, prognosis assessment, treatment plan selection, and the use of BTK inhibitors in CLL/SLL patients diagnosed and treated by the participating doctors.
The research results indicate that the 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. Most of the interviewed physicians conducted tests, such as bone marrow biopsies and immunohistochemistry, for patient diagnosis, in addition to the blood test. Only 13.7% of the interviewed physicians fully grasped the initial treatment indications recommended by the existing guidelines. In 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. Among 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%). BTKinhibitors 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. Some 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.
In summary, the results of this study show that there are still many shortcomings in the standardized diagnosis and treatment of CLL/SLL among Chinese doctors. Efforts need to be made from different levels and dimensions to improve the understanding of this disease among Chinese doctors at all levels, in order to further improve the level of CLL/SLL diagnosis and treatment in China.
