{"id":6182,"date":"2026-10-19T09:48:36","date_gmt":"2026-10-19T09:48:36","guid":{"rendered":"https:\/\/phd.hi.is\/doktorsvorn\/doktorsvorn-i-laeknavisindum-vilhjalmur-steingrimsson\/"},"modified":"2026-10-19T09:48:36","modified_gmt":"2026-10-19T09:48:36","slug":"doktorsvorn-i-laeknavisindum-vilhjalmur-steingrimsson","status":"publish","type":"phd_defence","link":"https:\/\/phd.hi.is\/en\/doktorsvorn\/doktorsvorn-i-laeknavisindum-vilhjalmur-steingrimsson\/","title":{"rendered":"Doktorsv\u00f6rn \u00ed l\u00e6knav\u00edsindum – Vilhj\u00e1lmur Steingr\u00edmsson"},"content":{"rendered":"
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F\u00f6studaginn 24. september ver Vilhj\u00e1lmur Steingr\u00edmsson doktorsritger\u00f0 s\u00edna \u00ed l\u00e6knav\u00edsindum vi\u00f0 L\u00e6knadeild H\u00e1sk\u00f3la \u00cdslands. Ritger\u00f0in ber heiti\u00f0: \u00a0<\/strong>Lifun og fylgikvillar \u00ed langvinnu eitilfrumuhv\u00edtbl\u00e6\u00f0i<\/strong>. Survival and complications in patients with chronic lymphocytic leukemia in the pre-ibrutinib era.<\/strong><\/p>\n

Andm\u00e6lendur eru dr. Carsten U. Niemann, pr\u00f3fessor vi\u00f0 Rigshospitalet \u00ed Danm\u00f6rku, og dr. Kristjana Hr\u00f6nn \u00c1sbj\u00f6rnsd\u00f3ttir, lektor \u00ed faraldsfr\u00e6\u00f0i vi\u00f0 H\u00e1sk\u00f3la \u00cdslands.<\/p>\n

Umsj\u00f3narkennari og lei\u00f0beinandi var dr. Sigur\u00f0ur Yngvi Kristinsson, pr\u00f3fessor vi\u00f0 L\u00e6knadeild. Auk hans s\u00e1tu \u00ed doktorsnefnd Magn\u00fas Gottfre\u00f0sson, pr\u00f3fessor vi\u00f0 L\u00e6knadeild, Magnus Bj\u00f6rkholm, pr\u00f3fessor vi\u00f0 Karolinska Institutet, og Ola Landgren, pr\u00f3fessor vi\u00f0 University of Miami.<\/p>\n

\u00de\u00f3rarinn Gu\u00f0j\u00f3nsson, pr\u00f3fessor og deildarforseti L\u00e6knadeildar, stj\u00f3rnar ath\u00f6fninni sem fer fram \u00ed H\u00e1t\u00ed\u00f0asal H\u00e1sk\u00f3la \u00cdslands og hefst kl. 9.00.<\/p>\n

V\u00f6rninni ver\u00f0ur streymt:\u00a0<\/strong><\/p>\n

https:\/\/livestream.com\/hi\/doktorsvornvilhjalmursteingrimsson<\/a><\/p>\n

\u00c1grip<\/strong><\/p>\n

Langvinnt eitilfrumuhv\u00edtbl\u00e6\u00f0i (CLL) er sj\u00fakd\u00f3mur sem leggst helst \u00e1 eldra f\u00f3lk, me\u00f0alaldur \u00feeirra sem greinast er um 72 \u00e1r. F\u00e1ar ranns\u00f3knir hafa meti\u00f0 hvernig fylgikvillar, lifun og d\u00e1narorsakir \u00ed CLL hafa breyst s\u00ed\u00f0an um aldam\u00f3t og \u00fe\u00e6r hafa flestar veri\u00f0 sm\u00e1ar \u00ed sni\u00f0um. Rannsaka\u00f0ar voru \u00feessar mikilv\u00e6gu breytingar \u00ed l\u00fd\u00f0grunda\u00f0ri ranns\u00f3kn.<\/p>\n

\u00de\u00fd\u00f0i\u00f0 var samansett \u00far sj\u00faklingum sem voru skr\u00e1\u00f0ir me\u00f0 CLL samkv\u00e6mt s\u00e6nsku krabbameinsskr\u00e1nni \u00e1rin 1982-2013. Fyrir hvern CLL sj\u00fakling var af handah\u00f3fi valinn samanbur\u00f0areinstaklingur af sama kyni og svipu\u00f0um aldri og b\u00fasetu. Umframd\u00e1nart\u00ed\u00f0nihlutfall (EMRR), \u00e1h\u00e6ttuhlutfall (HR) og tilfella-d\u00e1narhlutfall (CFR) voru reiknu\u00f0 me\u00f0 95% \u00f6ryggisbilum (95% CI). Byr\u00f0i fylgisj\u00fakd\u00f3ma var metin me\u00f0 Charlson fylgisj\u00fakd\u00f3maskori (CCI).<\/p>\n

\u00de\u00fd\u00f0i\u00f0 samanst\u00f3\u00f0 af 13,009 CLL sj\u00faklingum. Samanbori\u00f0 vi\u00f0 1982-1992 var EMRR 0.72 (95% CI 0.66-0.77) \u00e1rabili\u00f0 1993-2002 og 0.53 (0.48-0.58) \u00e1rabili\u00f0 2003-2013. CLL var a\u00f0ald\u00e1narors\u00f6k \u00ed 41-44% af \u00feeim sem l\u00e9tust og var \u00f3beint tengt allt a\u00f0 70% af andl\u00e1tum. \u00c1h\u00e6ttan af \u00fev\u00ed a\u00f0 deyja \u00far CLL minnka\u00f0i yfir ranns\u00f3knart\u00edmann (HR 0.78, 95% CI 0.75-0.81 fyrir hver 10 \u00e1r). Aukin byr\u00f0i fylgisj\u00fakd\u00f3ma var tengd verri horfum m.t.t. CLL (HR 1.35, 95% CI 1.25-1.45 og HR 1.47, 1.37-1.57 fyrir 1 og 2+ CCI stig, \u00ed s\u00f6mu r\u00f6\u00f0).<\/p>\n

N\u00fdgengi (IR) innlagna vegna bakter\u00edus\u00fdkinga var 15 \u00e1 100 sj\u00faklinga\u00e1r. Algengustu s\u00fdkingarnar voru lungnab\u00f3lgur (IR 10.5), bl\u00f3\u00f0s\u00fdking (IR 3.4), og h\u00fa\u00f0s\u00fdkingar (IR 1.0). \u00c1h\u00e6ttan af \u00fev\u00ed a\u00f0 leggjast inn vegna bakter\u00edus\u00fdkinga minnka\u00f0i \u00e1 ranns\u00f3knart\u00edmanum (HR 0.87, 0.81-0.94 \u00e1rin 1992-2002 og HR 0.76, 0.70-0.82 \u00e1rin 2003- 2013, samanbori\u00f0 vi\u00f0 1982-1992). Alls voru 829 innlagnir vegna t\u00e6kif\u00e6riss\u00fdkinga \u00ed 8,989 sj\u00faklingum sem greindust me\u00f0 CLL \u00e1rin 1994-2013. Algengasta s\u00fdkingin var lungnab\u00f3lga vegna Pneumocystis jirovecii (IR 4.03 \u00e1 1,000 sj\u00faklinga\u00e1r) og \u00e1h\u00e6ttan var einnig mest samanbori\u00f0 vi\u00f0 vi\u00f0mi\u00f0 (IRR 114, 95% CI 58.7-252). Alvarlegar herpes zoster s\u00fdkingar voru n\u00e6stalgengasta s\u00fdkingin (IR 2.94). N\u00e6st komu sveppas\u00fdkingar vegna Candida (IR 1.66) og Aspergillus (IR 1.20) og h\u00f6f\u00f0u \u00fe\u00e6r s\u00fdkingar mj\u00f6g sl\u00e6mar horfur (CFR 33% og 42%, \u00ed s\u00f6mu r\u00f6\u00f0).<\/p>\n

\u00cd st\u00f3rri l\u00fd\u00f0grunda\u00f0ri ranns\u00f3kn hefur veri\u00f0 s\u00fdnt a\u00f0 lifun CLL sj\u00faklinga hefur aukist undanfarna \u00e1ratugi. \u00deegar d\u00e1narorsakir voru sko\u00f0a\u00f0ar kom \u00ed lj\u00f3s a\u00f0 \u00fea\u00f0 var a\u00f0 st\u00f3rum hluta vegna b\u00e6ttrar lifunar m.t.t. CLL. Fylgikvillar jukust ekki \u00e1 ranns\u00f3knart\u00edmanum, \u00fevert \u00e1 m\u00f3ti var l\u00e6gri innlagnat\u00ed\u00f0ni vegna alvarlegra bakter\u00edus\u00fdkinga og \u00e1 \u00fev\u00ed a\u00f0 deyja \u00far s\u00fdkingum.<\/p>\n

English abstract<\/strong><\/p>\n

Introduction: <\/strong>Chronic lymphocytic leukemia (CLL) is a disease of the elderly and the median age of newly diagnosed patients is 72 years. To evaluate the effect of the treatment changes that occurred at the turn of the century, we performed a nationwide study on survival, causes of death, and infections in CLL patients.<\/p>\n

Methods: <\/strong>Information on CLL patients diagnosed 1982-2013 was obtained from the Swedish Cancer Registry. For each CLL patient, four controls matched for age, sex and place of residence were randomly allocated. Excess mortality rate ratios (EMRR), hazard ratios (HR), incidence rate ratio (IRR), and 60-days case fatality ratio (CFR) with 95% confidence intervals (95% CI) were estimated.<\/p>\n

Results: <\/strong>In the Swedish CLL cohort; 13,009 patients; survival increased over time. Compared to the calendar period 1982-1992, the EMRR adjusted for age and sex was 0.72 (95% CI 0.66-0.77) for 1993-2002 and 0.53 (95% CI 0.48-0.58) for 2003-2013. In general, CLL was the primary cause of death in 41-44% of the mortality and CLL was related to nearly 70% of the mortality. Over time, CLL decreased as a cause of death (HR 0.78, 95% CI 0.75-0.81 for 10-year increase in calendar year). Higher Charlson Comorbidity Index (CCI) was associated with increased risk of CLL-related mortality (HR 1.35, 95% CI 1.25-1.45 and HR 1.47, 1.37-1.57 for 1 and 2+ CCI points, respectively).<\/p>\n

The incidence rate (IR) of serious bacterial infections in the CLL cohort was 15 admissions per 100 patient years. The most common infections were pneumonia (IR 10.5), septicemia (IR 3.4) and skin infections (IR 1.0. The risk of infections decreased over time (HR 0.87, 0.81-0.94 in 1992-2002 and HR 0.76, 0.70-0.82 in 2003- 2013, compared to 1982-1992). In total, 829 opportunistic infections occurred in 8,989 CLL patients diagnosed 1994-2013. The most common infection was Pneumocystis jirovecii pneumonia (PCP, IR 4.03 per 1,000 patient years), and relative to matched controls, risk of PCP was also highest (IRR 114, 95% CI 58.7-252). Herpes zoster infections were the second most common opportunistic infections (IR 2.94). Finally, fungal infections with Candida and Aspergillus had an incidence of IR 1.66 and IR 1.20, respectively, and were associated with abysmal prognosis (CFR 33% and 42%, respectively).<\/p>\n

Conclusions: <\/strong>In these population-based studies we have established that survival improved in CLL patients during the study period. This was largely due to decreased CLL-related mortality. Importantly, admissions and mortality due to infections decreased significantly over time.<\/p>\n

Um doktorsefni\u00f0<\/strong><\/p>\n

Vilhj\u00e1lmur Steingr\u00edmsson er f\u00e6ddur \u00ed Reykjav\u00edk 14. apr\u00edl 1985. Hann lauk st\u00fadentspr\u00f3fi af e\u00f0lisfr\u00e6\u00f0ideild fr\u00e1 Menntask\u00f3lanum \u00ed Reykjav\u00edk 2005 og BSc. gr\u00e1\u00f0u \u00ed st\u00e6r\u00f0fr\u00e6\u00f0i fr\u00e1 H\u00e1sk\u00f3la \u00cdslands 2009. Vilhj\u00e1lmur lauk BSc. gr\u00e1\u00f0u \u00ed l\u00e6knisfr\u00e6\u00f0i fr\u00e1 H\u00e1sk\u00f3la \u00cdslands 2012 og emb\u00e6ttispr\u00f3fi \u00ed l\u00e6knisfr\u00e6\u00f0i 2015. A\u00f0 loknu kand\u00eddats\u00e1ri h\u00f3f hann s\u00e9rn\u00e1m \u00ed almennum lyfl\u00e6kningum \u00e1 Landsp\u00edtala og lauk \u00fear \u00feriggja \u00e1ra n\u00e1mi me\u00f0 MRCP-gr\u00e1\u00f0u 2020. Samhli\u00f0a n\u00e1mi og starfi sem l\u00e6knir hefur Vilhj\u00e1lmur stunda\u00f0 ranns\u00f3knarvinnu fr\u00e1 \u00e1rinu 2011. Foreldrar Vilhj\u00e1lms eru Linda R\u00f3s Michaelsd\u00f3ttir og Steingr\u00edmur Ari Arason. Eiginkona Vilhj\u00e1lms er Kristr\u00fan Gunnarsd\u00f3ttir hlj\u00f3\u00f0verkfr\u00e6\u00f0ingur og eiga \u00feau saman tvo drengi, \u00d3skar Kat\u00f3 og Ugga.<\/p>\n<\/div><\/div>","protected":false},"featured_media":4941,"template":"","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"_phd_date_start":"2021-09-24T09:00:00+00:00","_phd_date_end":"2021-09-24T12:00:00+00:00","_phd_location":"A\u00f0albygging H\u00e1t\u00ed\u00f0asalur","_phd_admission":"A\u00f0gangur \u00f3keypis","_phd_thesis_title":"Lifun og fylgikvillar \u00ed langvinnu eitilfrumuhv\u00edtbl\u00e6\u00f0i. 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