Intake of Proton Pump Inhibitors Is Associated with a Shorter Time to First Treatment in Early-Stage Chronic Lymphocytic Leukemia

Introduction: Proton pump inhibitors (PPIs) are one of the most widely used drugs worldwide [Gut Liver. 2017;11(1): 27–37]. The use of PPI has become a common practice and is overprescribed for all patients with cancer including patients with hematological malignancies. In the current study, we aimed to explore retrospectively the effect of PPI, on time to first treatment (TTFT) in a large cohort of patients with chronic lymphocytic leukemia (CLL) who were under watch-and-wait approach. Methods: The cohort is based on anonymized data obtained from electronic medical records of Maccabi Healthcare Services (MHS) members, who is the second-largest healthcare organization in Israel, with 2.5 million insured patients, and received a diagnosis of CLL during this period. Results: Our cohort included 3,474 patients with CLL who are treatment-naïve, and the median follow-up was 1,745 days (602–3,700). A total of 1,061 patients (30.5%) received a PPI agent, for a minimum of 3 months during the watch-and-wait period. The intake of PPI was found to be associated with a shorter TTFT: among PPI users, the 10-year treatment-free ratio is 79.2%, while among nonPPI users it is 90.6%. Conclusion: Routine use of PPI in CLL patients may negatively impact their clinical course. Biology of this primary observation requires further investigation.