The National Cancer Data Base Report on age, gender, treatment, and outcomes of patients with chronic lymphocytic leukemia

Abstract

BACKGROUND The natural history of chronic lymphocytic leukemia (CLL) is changing, although the reasons (potential changes in the disease's biology or in patterns in patient characteristics, treatment, or referral) are unclear. METHODS This report uses National Cancer Data Base (NCDB) data, which reflect a hospital‐based patient population from a broad spectrum of hospitals in the United States. Age, gender, race/ethnicity, income, treatment, overall survival, and relative survival were evaluated according to time period (1985–1990 and 1991–1995). Comparisons were made with U.S. population figures for 1990 and with series published over the last 70 years. RESULTS CLL comprised 22.6% of the 108,396 cases of leukemia in the data base. The risk of developing CLL increased progressively with age and did not plateau; the average age was 69.6 years. At the time of initial diagnosis, 60.5% of patients received no treatment (this proportion increased from 58.1% to 62.7% between the 2 time periods). Overall survival was 48.2% at 5 years and 22.5% at 10 years. The 5‐year relative survival was 69.5%, 72.2%, 63.1%, and 41.7% for age groups <40, 40–59, 60–79, and 80+ years, respectively; these rates indicated that CLL, and not comorbid disease, caused the greatest percentage of deaths. CONCLUSIONS The risk of developing CLL increases progressively with age without plateauing and is 2.8 times higher for older men than for older women. There is an increasing trend toward no treatment at the time of initial diagnosis. Long term overall survival of CLL patients is poor. CLL is a more fatal disease among older individuals because of the disease itself, not because of comorbid conditions. Cancer 1999;86:2684–92. © 1999 American Cancer Society.

Genomic characterization of high-count MBL cases indicates that early detection of driver mutations and subclonal expansion are predictors of adverse clinical outcome

“…(1, 2) The discovery of the CLL genetic landscape has significantly improved our understanding of which patients are more likely to experience an aggressive disease. In addition to the well-established role of TP53 in clinical outcome, mutations in NOTCH1 , SF3B1, and BIRC3 have been recently associated with differential prognosis and subsequently incorporated in the risk stratification.…”

miR-26a and miR-214 down-regulate expression of the PTEN gene in chronic lymphocytic leukemia, but not PTEN mutation or promoter methylation

“…Chronic lymphocytic leukemia (CLL) is the most common type of adult leukemia in the Western societies [1], but low incidence in Asian countries, including China [2, 3]. With the coming of aging society and the westernization of lifestyle, increasing incidence has been reported in recent years in Asia [4].…”

Age at diagnosis and the utility of prognostic testing in patients with chronic lymphocytic leukemia

“…1 The prevalence of CLL increases with age and the median age at the time of diagnosis is between 65 and 70 years. 2-6 Recent studies suggest that the 5 year survival of CLL patients of all ages has increased over the last two decades, 6-8 likely due in part to early stage at diagnosis. 3,4,6,9 The absolute 10 year survival of patients with CLL has increased by ~10% for patients of all ages except those over age 80 years 7,8 .…”

“…10 Although numerous clinical and biologic parameters are able to predict survival and time to first treatment (TFT), 10-15 the utility of these prognostic parameters may vary based on age given the higher mortality from competing health problems in older individuals. 7,16,17 Indeed there remains a strong age gradient in the survival among CLL patients 2,7,8,18 where the expected 10 year survival for those less than age 60 is 59% compared to 6% for those over age 80. 7 Accordingly, while risk stratification using leukemia cell biomarkers (e.g.…”