中国慢性淋巴细胞白血病/小淋巴细胞淋巴瘤诊疗现状:一项多中心问卷调查研究  

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

作　　者：徐卫[1] 易树华 冯茹[3] 王欣[4] 金洁[5] 糜坚青[6] 丁凯阳 杨威[8] 牛挺[9] 王少元[10] 周可树 彭宏凌[12] 黄亮[13] 刘丽宏 马军 罗军[16] 苏丽萍[17] 白鸥[18] 刘林[19] 李菲[20] 贺鹏程[21] 曾云[22] 高大[23] 江明[24] 王季石 姚红霞[26] 邱录贵 李建勇[1] 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

机构地区：[1]江苏省人民医院(南京医科大学第一附属医院),南京210029 [2]中国医学科学院血液病医院(中国医学科学院血液学研究所),实验血液学国家重点实验室,国家血液系统疾病临床医学研究中心,细胞生态海河实验室,天津300020 [3]南方医科大学南方医院,广州510515 [4]山东省立医院,济南250021 [5]浙江大学医学院附属第一医院,杭州310003 [6]上海交通大学医学院附属瑞金医院,上海200025 [7]中国科学技术大学附属第一医院,合肥230031 [8]中国医科大学附属盛京医院,沈阳117004 [9]四川大学华西医院,成都610044 [10]福建医科大学附属协和医院,福州350001 [11]河南省肿瘤医院(郑州大学附属肿瘤医院),郑州450003 [12]中南大学湘雅二医院,长沙410008 [13]华中科技大学同济医学院附属同济医院,武汉430030 [14]河北医科大学第四医院(河北省肿瘤医院),石家庄050011 [15]哈尔滨血液肿瘤研究所,哈尔滨150001 [16]广西医科大学第一附属医院,南宁530021 [17]山西省肿瘤医院,太原030013 [18]吉林大学第一医院,长春130061 [19]重庆医科大学附属第一医院,重庆400042 [20]南昌大学第一附属医院,南昌330006 [21]西安交通大学第一附属医院,西安710061 [22]昆明医科大学第一附属医院,昆明650032 [23]内蒙古医科大学附属医院,呼和浩特750306 [24]新疆医科大学第一附属医院,乌鲁木齐830011 [25]贵州医科大学附属医院,贵阳550004 [26]海南省人民医院,海口570311

出　　处：《中华血液学杂志》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。

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 i

关 键 词：慢性淋巴细胞白血病 问卷调查研究 诊断 治疗 

分 类 号：R733.72[医药卫生—肿瘤]