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Incidence of second primary malignancies in relapsed/refractory B-cell non-Hodgkin's lymphoma patients in England. Leuk Res 2023; 127:107042. [PMID: 36812661 DOI: 10.1016/j.leukres.2023.107042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/20/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Treatments for relapsed/refractory (r/r) B-cell non-Hodgkin's lymphoma (NHL) may be associated with an increased risk of second primary malignancies (SPMs). Currently available SPM incidence benchmarks are unreliable due to small sample sizes. METHODS The Cancer Analysis System (CAS), a population-level cancer database in England, was used to identify patients with incident B-cell NHL diagnosed during 2013-2018 with evidence of r/r disease. Incidence rates (IRs) of SPMs after r/r disease diagnosis were calculated per 1000 person-years (PYs) and stratified by age, sex, and SPM type. RESULTS We identified 9444 patients with r/r B-cell NHL disease. Of those who were eligible for SPM analysis, nearly 6.0% (470/7807) developed at least one SPM after r/r disease diagnosis (IR: 44.7; 95% confidence interval [CI]: 40.9-48.9). Of note, 205 (2.6%) had a non-melanoma skin cancer (NMSC) SPM. IR of SPMs was the highest for patients with r/r chronic lymphocytic leukemia/small lymphocytic leukemia (80.0) and lowest for diffuse large B-cell lymphoma (DLBCL) (30.9). Patients with DLBCL had the shortest overall survival after r/r disease diagnosis. CONCLUSIONS This real-world data study suggests that the IR of SPM among patients with r/r B-cell NHL is 44.7 per 1000 PY and that most SPMs diagnosed after r/r disease diagnosis are NMSCs, establishing a basis for the comparison of safety outcomes for new treatments being developed for r/r B-cell NHL.
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2
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Meiotic drive in chronic lymphocytic leukemia compared with other malignant blood disorders. Sci Rep 2022; 12:6138. [PMID: 35413962 PMCID: PMC9005523 DOI: 10.1038/s41598-022-09602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/22/2022] [Indexed: 11/12/2022] Open
Abstract
The heredity of the malignant blood disorders, leukemias, lymphomas and myeloma, has so far been largely unknown. The present study comprises genealogical investigations of one hundred and twelve Scandinavian families with unrelated parents and two or more cases of malignant blood disease. For comparison, one large family with related family members and three hundred and forty-one cases of malignant blood disease from the Faroese population was included. The inheritance is non-Mendelian, a combination of genomic parental imprinting and feto-maternal microchimerism. There is significantly more segregation in maternal than in paternal lines, predominance of mother-daughter combinations in maternal lines, and father-son combinations in paternal lines. Chronic lymphocytic leukemia is the most frequent diagnosis in the family material, and chronic lymphocytic leukemia has a transgenerational segregation that is unique in that inheritance of susceptibility to chronic lymphocytic leukemia is predominant in males of paternal lines. Male offspring with chronic lymphocytic leukemia in paternal lines have a birth-order effect, which is manifest by the fact that there are significantly more male patients late in the sibling line. In addition, there is contravariation in chronic lymphocytic leukemia, i.e. lower occurrence than expected in relation to other diagnoses, interpreted in such a way that chronic lymphocytic leukemia remains isolated in the pedigree in relation to other diagnoses of malignant blood disease. Another non-Mendelian function appears in the form of anticipation, i.e. increased intensity of malignancy down through the generations and a lower age at onset of disease than otherwise seen in cases from the Cancer Registers, in acute lymphoblastic leukemia, for example. It is discussed that this non-Mendelian segregation seems to spread the susceptibility genes depending on the gender of the parents and not equally to all children in the sibling line, with some remaining unaffected by susceptibility i.e. "healthy and unaffected", due to a birth order effect. In addition, anticipation is regarded as a non-Mendelian mechanism that can amplify, «preserve» these vital susceptibility genes in the family. Perhaps this segregation also results in a sorting of the susceptibility, as the percentage of follicular lymphoma and diffuse large B-cell lymphoma is lower in the family material than in an unselected material. Although leukemias, lymphomas and myelomas are potentially fatal diseases, this non-Mendelian distribution and amplification hardly play any quantitative role in the survival of Homo sapiens, because these diseases mostly occur after fertile age.
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Cabrera ME, Marinov N, Roa M, Castillo JJ, Matutes E. Epidemiology of chronic lymphocytic leukemia in Chilean and Amerindian population in Chile. Leuk Lymphoma 2021; 63:1137-1143. [PMID: 34886754 DOI: 10.1080/10428194.2021.2012663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The study aim was to analyze incidence and presentation features of chronic lymphocytic leukemia (CLL) in Chile, in Amerindian population and in non-Native. Between 2012 and 2019, 912 patients were diagnosed, and 13 (1.4%) were Amerindian. The estimated incidence in Chilean population was 1.17/100,000 person per year, while in Amerindian, 0.09/100,000 person per year. Median age was 73 years. At diagnosis, 48, 27, and 25%, had low (0), intermediate (I/II) and high-risk (III/IV) disease on Rai classification. Diagnostic immunophenotypic Matutes score was ≥4 in 90%. Median follow-up was 37 months (range 2-87). 5-year OS was 56%, with median overall survival (OS) not reached. It was worse in men, ≥65 years, high-risk and those with increased prolymphocytes (CLL/PL). This study shows low incidence and worse OS in Chilean CLL patients, compared to those from European countries, despite similar clinical features. It also demonstrates that CLL is very uncommon in Amerindian population.
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Affiliation(s)
- María Elena Cabrera
- Medicine Service, Hematology Section, Hospital del Salvador, Universidad de Chile, Santiago de Chile, Chile
| | - Neda Marinov
- Hematologia, Hospital Del Salvador, Santiago, Chile
| | - Macarena Roa
- Hematologia, Hospital Del Salvador, Santiago, Chile
| | | | - Estella Matutes
- Haematopathology, Hospital Clinic Barcelona, Barcelona, Spain
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4
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Steingrímsson V, Lund SH, Dickman PW, Weibull CE, Björkholm M, Landgren O, Kristinsson SY. Survival, causes of death, and the prognostic role of comorbidities in chronic lymphocytic leukemia in the pre-ibrutinib era: A population-based study. Eur J Haematol 2021; 108:145-153. [PMID: 34714556 DOI: 10.1111/ejh.13720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/15/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate temporal trends in survival and causes of death in patients with chronic lymphocytic leukemia (CLL) in a nationwide study. METHODS The cohort consisted of 13,009 Swedish CLL patients diagnosed 1982-2013. Relative survival (RS) and excess mortality rate ratios (EMRR) with 95% confidence intervals (95% CIs) were estimated using flexible parametric survival models. Cause-specific hazard ratios (HRs) were estimated for the linear effect of 10-year increase in year of diagnosis. RESULTS The excess mortality decreased comparing 2003-2013 to 1982-1992 (EMRR = 0.53, 95% CI 0.48-0.58). The 5-year RS increased between 1982 and 2012 for patients >51 years at diagnosis and improved for patients ≤51 years after 2002. The rate of CLL-specific deaths decreased over time (HR = 0.78, 95% CI 0.75-0.81). Compared to patients with no comorbidity, patients with 1 and 2+ Charlson Comorbidity Index points had HR = 1.35 (95% CI 1.25-1.45) and HR = 1.47 (95% CI 1.37-1.57) for CLL-related mortality, respectively. CONCLUSION Survival in CLL patients improved in the era of chemoimmunotherapy, and this was largely explained by reduced CLL-related mortality. The increased rate of CLL-related mortality in patients with comorbidities emphasizes the importance of the newer and better tolerated targeted therapy.
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Affiliation(s)
| | - Sigrún H Lund
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Caroline E Weibull
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - Magnus Björkholm
- Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Ola Landgren
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - Sigurður Y Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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5
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Cardoso Borges F, Ramos A, Lourenço A, Gomes da Silva M, Miranda A. Detailing the epidemiological and clinical characteristics of chronic lymphocytic leukaemia in Portugal-Results from a population-based cancer registry cohort study. PLoS One 2021; 16:e0258423. [PMID: 34624053 PMCID: PMC8500441 DOI: 10.1371/journal.pone.0258423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chronic lymphocytic leukaemia (CLL) is the most common leukaemia among adults in western countries. Considering the increasing incidence and prevalence of this condition, it is highly relevant to better characterise these patients in Portugal, where data is still scarce. METHODS To determine incidence, clinical presentation, survival and second malignancies, a population-based historical cohort study was conducted. Cases of interest were identified through the South Region Cancer Registry database and additional data sources. Patients aged ≥18 years, with a confirmed diagnosis of CLL or small lymphocytic lymphoma between January 1st, 2013 and December 31st, 2014 were included. Patients were followed-up until death or cut-off date (December 31st, 2019). RESULTS A total of 496 patients were included and median follow-up time was 5.46 years. Crude incidence rates were 5.03 and 5.22 per 100,000 inhabitants for 2013 and 2014, respectively, and age-adjusted incidence rates were 3.18:100,000 European population for 2013 and 3.35:100,000 European population for 2014. Median age at diagnosis was 71 years and the male/female ratio was 1.40. The majority of patients had leukemic presentation of the disease (86.09%), was diagnosed in Binet stage A (75.58%) and did not present B symptoms (84.01%), anaemia (haemoglobin ≤10g/dL; 90.63%) nor thrombocytopenia (platelet count ≤100 000/μL; 91.73%). Five-year overall survival (OS) rate was 70.53% (95%CI 66.31-74.34) and age, lactate dehydrogenase, Binet stage and a ≥5 Charlson comorbidity index score were independently associated with OS. Standardised-incidence ratios for any second malignancy and cutaneous squamous cell carcinoma were 1.59 (95%CI 1.19-2.08) and 10.15 (95%CI 6.28-15.51), respectively. CONCLUSION Incidence, clinical presentation and survival of CLL Portuguese patients are similar to those reported for other western countries. The increased risk of second malignancies raises concerns and needs adequate clinical watchfulness.
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Affiliation(s)
- Fábio Cardoso Borges
- National Cancer Registry, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisboa, Portugal
| | - Adriana Ramos
- National Cancer Registry, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisboa, Portugal
| | - António Lourenço
- National Cancer Registry, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisboa, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Maria Gomes da Silva
- Haematology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisboa, Portugal
| | - Ana Miranda
- National Cancer Registry, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisboa, Portugal
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Vanura K. Sex as decisive variable in lymphoid neoplasms-an update. ESMO Open 2020; 6:100001. [PMID: 33399069 PMCID: PMC7808098 DOI: 10.1016/j.esmoop.2020.100001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/09/2020] [Accepted: 10/31/2020] [Indexed: 01/26/2023] Open
Affiliation(s)
- K Vanura
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria.
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Weil C, Chodick G, Shalev V, Kan I, Afik R, Cohen R, Sail K, Herishanu Y. Epidemiology, longitudinal treatment patterns and outcomes of chronic lymphocytic leukemia in Israel. Leuk Lymphoma 2020; 62:1136-1145. [PMID: 33305641 DOI: 10.1080/10428194.2020.1858293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aims to describe chronic lymphocytic leukemia (CLL) epidemiology, treatment patterns and outcomes in a 2.3-million-member healthcare provider database (Maccabi Healthcare Services, Israel). Newly-diagnosed CLL patients (1999-2017) were followed through 31/3/2018. A total of 1857 newly-diagnosed CLL patients were included. Annual incidence was 5.82 per 100,000 population. Median overall survival (OS) was 12.7 (95%CI: 11.8-13.5) years since diagnosis. Approximately 1/3 initiated treatment within 5 y. A statistical trend (p = 0.066) for improved OS over time was observed among younger patients (age <70 y) treated in 2009-2017 vs. 1999-2008). Among patients treated since 2009 (n = 411; median age = 68y), fludarabine-cyclophosphamide-rituximab (FCR), bendamustine-rituximab and obinutuzumab ± chlorambucil accounted for 19.5%, 12.2% and 11.4% of first line, respectively. Median (95%CI) time to next treatment and OS were 3.1(2.6-3.6) and 7.0(6.3-7.7) years, respectively. CLL incidence in Israel is comparable to developed countries. Real-world data suggest a trend of improved survival over the last decade among patients treated before age 70.
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Affiliation(s)
- Clara Weil
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, Tel Aviv, Israel
| | - Gabriel Chodick
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Varda Shalev
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inna Kan
- AbbVie Inc, Hod Hasharon, Israel
| | - Ran Afik
- AbbVie Inc, Hod Hasharon, Israel
| | | | | | - Yair Herishanu
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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8
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Bravaccini S, Martinelli G, Cerchione C. What Influences the Choice of Ibrutinib-Rituximab vs Classic Chemoimmunotherapy for Chronic Lymphocytic Leukemia? Cell Transplant 2020; 29:963689720950209. [PMID: 32907382 PMCID: PMC7784498 DOI: 10.1177/0963689720950209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL), with an incidence rate between 4 and 6 cases per 100,000 persons per year, is considered the most prevalent leukemia in the western world. Chemoimmunotherapy (such as fludarabine, cyclophosphamide, and rituximab), bendamustine plus rituximab, and, more recently, novel agents such as ibrutinib (Bruton tyrosine kinase inhibitor), idelalisib (phosphatidylinositol-3-kinase δ inhibitor), and venetoclax (BCL-2 inhibitor) have changed the management of CLL. Shanafelt and colleagues compared the efficacy of ibrutinib–rituximab with that of standard chemoimmunotherapy in patients with treatment-naïve CLL. They did not, however, mention that the therapy varies on the basis of where patients live and, given that local guidelines not immediately reflect US Food and Drug Administration (FDA) updates, discrepancies in treatment occur. Important CLL goals are the availability of rapidly reproducible tests, standardization of national and international guidelines, and FDA approval-based treatment reimbursement.
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Affiliation(s)
- Sara Bravaccini
- 124882Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Emilia-Romagna, Italy
| | - Giovanni Martinelli
- 124882Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Emilia-Romagna, Italy
| | - Claudio Cerchione
- 124882Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Emilia-Romagna, Italy
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9
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Lenartova A, Johannesen TB, Tjønnfjord GE. Chronic lymphocytic leukemia and secondary hematological malignancies: A nation-wide cancer registry study. Eur J Haematol 2020; 104:546-553. [PMID: 32058605 DOI: 10.1111/ejh.13396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Chronic lymphocytic leukemia (CLL) treatment has changed dramatically, and landscape of second hematologic malignancies (SHM) evolves in the new era of targeted therapy. No data were available about the real-world burden of SHM. METHODS All 2631 patients with CLL in the Cancer registry of Norway registered 2003-2012 were included. RESULTS After median follow-up of 6.6 years, 103 patients (4%) developed SHM. Diffuse large B-cell lymphoma (DLBCL) was most common (n = 65; 63%). Median survival was 9.3 years (95% CI; 8.9-9.8) in non-SHM patients and 1.7 years in DLBCL, 0.8 years in Hodgkin lymphoma (n = 12), and 2.8 years in myeloid neoplasia (n = 15; 95% CI: 0.3-2.6, 0.6-2.9, and 0.4-5.3, respectively; P < .001). Outcomes were poorest for SHM patients treated for CLL (HR 2.76, 95% CI 1.4-5.5, P = 0.003). A higher proportion of men and younger age were found in SHM patients (median age 66 vs 72 years in non-SHM; P < .001; men 68% vs 57%, P = .03). Myeloid neoplasia was rare (incidence rate 1/1000 person-years; 95% CI: 0.6-1.5) and tended to occur later than DLBCL in patients treated for CLL (median time from CLL to SHM 62 vs 45 months; P = .09). CONCLUSIONS SHM and especially myeloid malignancies were rare in chemoimmunotherapy era.
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Affiliation(s)
- Andrea Lenartova
- Department of Hematology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Geir Erland Tjønnfjord
- Department of Hematology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,K.G.Jebsen Centre for B-Cell Malignancies, University of Oslo, Oslo, Norway
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10
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Weide R, Feiten S, Chakupurakal G, Friesenhahn V, Kleboth K, Köppler H, Lutschkin J, van Roye C, Thomalla J, Heymanns J. Survival improvement of patients with chronic lymphocytic leukemia (CLL) in routine care 1995-2017. Leuk Lymphoma 2019; 61:557-566. [PMID: 31682164 DOI: 10.1080/10428194.2019.1680840] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Seven hundred and twenty-four CLL-outpatients with a median age of 67 (35-92) were analyzed. Four hundred and twenty-seven (59%) were male, 297 (41%) female. At diagnosis 556 (77%) were in Binet stage A, 91 (13%) stage B and 36 (5%) stage C. Forty-six percent received treatment during the evaluation period. Treatment consisted of purine analogs in 38%, alkylating agents in 96%, chemoimmunotherapy with anti-CD20 monoclonal antibodies in 63%, ibrutinib in 9%, venetoclax in 1% and idelalisib in 3%. 3% received allogeneic hematopoietic stem cell transplantation. Overall survival (OS) according to Binet stage was: A 13.9 years (0.1-37.4), B 9.2 years (1.4-29.3) and C 7.9 years (0.5-19.4) respectively. Median OS from the start of therapy improved over time; 1995-2001: 5.8 years, 2002-2008: 6.1 years and 2009-2017: median not reached. Survival of patients with CLL has improved in routine care and was strongly related to active disease, disease stage, performance status and whether therapy included an anti-CD20 monoclonal antibody.
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Affiliation(s)
- Rudolf Weide
- Praxis für Hämatologie und Onkologie, Koblenz, Germany
| | - Stefan Feiten
- Institut für Versorgungsforschung in der Onkologie, Koblenz, Germany
| | | | - Vera Friesenhahn
- Institut für Versorgungsforschung in der Onkologie, Koblenz, Germany
| | - Kristina Kleboth
- Institut für Versorgungsforschung in der Onkologie, Koblenz, Germany
| | | | - Julia Lutschkin
- Institut für Versorgungsforschung in der Onkologie, Koblenz, Germany
| | | | - Jörg Thomalla
- Praxis für Hämatologie und Onkologie, Koblenz, Germany
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Skånland SS, Cremaschi A, Bendiksen H, Hermansen JU, Thimiri Govinda Raj DB, Munthe LA, Tjønnfjord GE, Taskén K. An in vitro assay for biomarker discovery and dose prediction applied to ibrutinib plus venetoclax treatment of CLL. Leukemia 2019; 34:478-487. [DOI: 10.1038/s41375-019-0569-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/08/2019] [Accepted: 07/17/2019] [Indexed: 01/10/2023]
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12
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Lindström V, Hakkarainen KM, Mehtälä J, Klement R, Leval A, Järvinen TM. Observational evidence from patients diagnosed with chronic lymphocytic leukaemia (CLL) in Finland between 2005-2015 show improved survival over time. Eur J Haematol 2019; 103:190-199. [PMID: 31210368 PMCID: PMC6851967 DOI: 10.1111/ejh.13273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We aimed to describe treatment patterns of chronic lymphocytic leukaemia (CLL) patients in routine practice settings, compare overall survival and time-to-next-treatment among patients treated in different time periods (2005-2008, 2009-2013, 2014-2015), and explore associated factors. METHODS This retrospective cohort study included adult CLL patients from the Finnish Hematology Registry. RESULTS In total, 124 and 64 CLL patients received first- and second-line treatments, respectively. The use of first- and second-line treatments with bendamustine-rituximab (BR) increased, while chlorambucil-based treatments decreased over time. Patients treated in more recent years showed a trend towards longer first- and second-line survival. A trend towards inferior overall survival was detected in first- and second-line treatment with B/BR. First-line time-to-next-treatment was longer for patients treated in the later years towards 2015, while second-line time-to-next-treatment did not improve over time. CONCLUSIONS This study identified that improved treatment outcomes over time were likely influenced by patient characteristics and treatments, but also through other factors unexplored in this study. Hence, further research on the factors influencing patients' survival over time is needed. In particular, research on using B/BR in clinical practice is warranted.
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Affiliation(s)
- Vesa Lindström
- Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland
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13
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Lenartova A, Randen U, Johannesen TB, Tjønnfjord GE. Richter syndrome epidemiology in a large population based chronic lymphocytic leukemia cohort from Norway. Cancer Epidemiol 2019; 60:128-133. [DOI: 10.1016/j.canep.2019.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 12/17/2022]
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14
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Yang S, Gale RP, Shi H, Liu Y, Lai Y, Lu J, Huang X. Is there an epidemic of chronic lymphocytic leukaemia (CLL) in China? Leuk Res 2018; 73:16-20. [PMID: 30176386 DOI: 10.1016/j.leukres.2018.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/01/2018] [Accepted: 08/05/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chronic lymphocytic leukaemia (CLL) is 10- to 20-fold less common in Asians (including Han Chinese) compared with persons of predominately European descent. Why is unknown but seems predominately genetic. We observed an increasing frequency of new cases of CLL at our Haematology Centre beginning 2011 and wondered why. OBJECTIVE Determine the cause(s) for this increased frequency. METHOD We interrogated the context of CLL diagnosis in 483 consecutive subjects seen at the Institute of Haematology of a large referral hospital in Beijing. 3 cohorts were considered based on why a CBC was done to establish the CLL diagnosis: (1) a CBC-testing situation unrelated to a health condition such as a routine annual health exam or application for employment or medical insurance (termed routine CBC); (2) an unrelated medical condition such as a cold, influenza, heart disease etc. (termed CBC for other disorders); and (3) signs and/or symptoms consistent with CLL such as lymph-adenopathy, hepato- or splenomegaly, fatigue, B-symptoms etc. (termed CBC for possible CLL). RESULTS Data regarding context of CLL diagnosis were available for 389 subjects (81%). Proportions of subjects in the 3 cohorts were 44% (95% confidence interval [CI]; 39, 49%), 24% (20, 28%) and 32% (28, 37%). The proportion of subjects whose evaluation of CLL was prompted by an abnormal CBC not for possible CLL (cohorts 1 and 2) increased over the surveillance interval (r = 0.164; P = 0.001) as did median age at diagnosis (r = 0.207; P < 0.001). Age at diagnosis was correlated with probability of CLL being suspected because of an abnormal routine CBC (r = 0.249; P < 0.001); 42% (32, 53%) amongst subjects ≤50 years versus 86% (75, 92%; P < 0.001) among those >70 years. Consistent with this, older subjects were diagnosed at Rai stage-0 with asymptomatic disease compared with younger subjects (P < 0.001). CONCLUSION Our data suggest much of the increased frequency of CLL at our centre and likely elsewhere in China predominately reflects ascertainment bias. Other variables may also operate.
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Affiliation(s)
- Shenmiao Yang
- Peking University Peoples Hospital, Peking University Institute of Hematology, China
| | - Robert Peter Gale
- Haematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, SW7 2AZ, UK.
| | - Hongxia Shi
- Peking University Peoples Hospital, Peking University Institute of Hematology, China
| | - Yanrong Liu
- Peking University Peoples Hospital, Peking University Institute of Hematology, China
| | - Yueyun Lai
- Peking University Peoples Hospital, Peking University Institute of Hematology, China
| | - Jin Lu
- Peking University Peoples Hospital, Peking University Institute of Hematology, China
| | - Xiaojun Huang
- Peking University Peoples Hospital, Peking University Institute of Hematology, China; Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.
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Challenges in assessing the real incidence of chronic lymphocytic leukemia: 16 years of epidemiological data from the province of Girona, Spain. Cancer Causes Control 2018; 29:379-382. [DOI: 10.1007/s10552-018-1004-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/27/2018] [Indexed: 11/26/2022]
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16
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Puła A, Stawiski K, Braun M, Iskierka-Jażdżewska E, Robak T. Efficacy and safety of B-cell receptor signaling pathway inhibitors in relapsed/refractory chronic lymphocytic leukemia: a systematic review and meta-analysis of randomized clinical trials. Leuk Lymphoma 2017; 59:1084-1094. [DOI: 10.1080/10428194.2017.1375101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Anna Puła
- Department of Hematology, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Konrad Stawiski
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Marcin Braun
- Department of Pathology, Chair of Oncology, Medical University of Lodz, Lodz, Poland
- Postgraduate School of Molecular Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
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17
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Lenartova A, Johannesen TB, Tjønnfjord GE. National trends in incidence and survival of chronic lymphocytic leukemia in Norway for 1953-2012: a systematic analysis of population-based data. Cancer Med 2016; 5:3588-3595. [PMID: 27925456 PMCID: PMC5224846 DOI: 10.1002/cam4.849] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/22/2016] [Accepted: 07/11/2016] [Indexed: 12/31/2022] Open
Abstract
Chronic lymphocytic leukemia is a disease of the elderly, and despite major advances in treatment, remains incurable. The Cancer Registry of Norway has registered data on patients with chronic lymphocytic leukemia since 1953. We aimed to analyze trends in incidence and survival of chronic lymphocytic leukemia in Norway. We identified 7664 patients reported with chronic lymphocytic leukemia to the registry between 1953 and 2012. We gathered information on sex, age at diagnosis, date of death and basis for diagnosis. The age‐standardized incidence increased from 0.6/100.000 person‐years in 1953 to 3.1/100,000 person‐years in 2012. We found a significant decrease in median age between 1993–2002 and 2003–2012 (75 vs. 72 years, 95%CI: 2.52–3.98, P < 0.001). Men were diagnosed at a significantly younger age than women. Immunophenotyping has become the most important diagnostic method after 2002. Median observed survival increased from 3 years in 1952–1963 to 8.5 years in 2003–2012. Five‐ and 10‐year age‐standardized net survival increased throughout the whole period across age groups and reached 79% and 57%, respectively. Median observed survival was significantly shorter in men than in women in 1993–2002 (4.9 vs. 6.1 years, P < 0.001). The gap between survival rates for men and women was diminishing in 2003–2012 in patients younger than 60 years while it remained considerable in older patients. Despite an aging Norwegian population, chronic lymphocytic leukemia (CLL) patients become younger at diagnosis. A fourfold increase in incidence, a prolonged survival, and major changes in diagnostic methods in Norway were observed.
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Affiliation(s)
- Andrea Lenartova
- Department of Haematology, Oslo University Hospital, P.O.Box 4950 Nydalen, Oslo, 0424, Norway.,The Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Geir Erland Tjønnfjord
- Department of Haematology, Oslo University Hospital, P.O.Box 4950 Nydalen, Oslo, 0424, Norway.,The Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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