Abstract
There has been marked improvement in leukemia survival, particularly among children in recent time. However, the long-term trends in survival among adult leukemia patients and the associated sex and racial survival disparities are not well understood. We, therefore, evaluated the secular trends in survival improvement of leukemia patients from 1973 through 2014, using Surveillance Epidemiology and End-Result Survey Program (SEER) data. ICD-O-3 morphology codes were used to group leukemia into four types: acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML). Survival analysis for each leukemia type stratified by race/ethnicity, age, sex was performed to generate relative survival probability estimates for the baseline time period of 1973 through 1979. Hazard ratios (HR) and respective 95% confidence intervals (CIs) for survival within subsequent 10-year time periods by race, age and sex were calculated using Cox proportional hazard models. Of the 83,255 leukemia patients for the current analysis, the 5-year survival of patients with ALL, AML, CLL, and CML during 1973–1979 were 42.0%, 6.5%, 66.5%, and 20.9%, respectively. Compared to the baseline, there were substantial improvements of leukemia-specific survival in 2010–2014 among African-American (81.0%) and Asian (80.0%) patients with CML and among 20–49 year of age with CLL (96.0%). African-American patients, those with AML and those older than 75 years of age had the lowest survival improvements. Asians experienced some of the largest survival improvements during the study period. Others, including African-American and the elderly, have not benefited as much from advances in leukemia treatment.
Highlights
Leukemia is the 9th most common cancer in the United States and the 6th leading cause of cancer-related death with an incidence and mortality rates of 13.8 and 6.7 persons per 100,000 respectively [1]
Men were more likely to be reported as leukemia cases than women, among all leukemia patients, the proportion of those with chronic lymphoid leukemia (CLL) steadily increased throughout the study period, from 43.2% in 1973–1979 to 49.4% in 2010–2014 (Table 1 and S2–S6 Tables)
There was an improvement in leukemia survival among all racial/ethnic groups, most age groups and between the sexes, with Asians/Pacific Islanders, patients 20–49 years of age and men demonstrating the largest improvement in 5-year relative survival (39.4%, 47.0% and 34.6%, respectively), from the 1973–1979 baseline period to the current 2010–2014 period (Table 2)
Summary
Leukemia is the 9th most common cancer in the United States and the 6th leading cause of cancer-related death with an incidence and mortality rates of 13.8 and 6.7 persons per 100,000 respectively [1]. Chronic leukemia which affects adults tend to have a more favorable survival compared to AML, with the five-year survival of chronic myeloid leukemia (CML) and chronic lymphoid leukemia (CLL) reported as 69% and 66%, respectively, during 2007–2009 [6,7]. Several factors are known to explain the survival differences in patients with leukemia, including access to more advanced therapy, strict inclusion criteria in clinical trials testing novel therapies which tends to exclude certain populations (i.e., minorities, the elderly and women), genetic differences (i.e., Philadelphia chromosome in CML), socioeconomic status and differences in patient preferences regarding treatment [8,9,10,11,12]; our knowledge of long term patterns of survival incorporating recent time periods among adults is limited. We investigated the secular trends of survival among leukemia patients by ethnicity/race, age and sex from 1973 through 2014, using SEER data
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