Survival trends in chronic lymphocytic leukemia across treatment eras: US SEER database analysis (1985–2017)

7524 Background: The survival of chronic lymphocytic leukemia (CLL) patients has progressively improved after the approval of new targeted therapy for first-line treatment and relapsed disease. We performed a corresponding analysis from the U.S. population-based SEER database (1973–2017) to explore the trend of survival and the effect of advanced CLL treatment on overall survival in CLL patients. Methods: Data were extracted from SEER*Stat for all patients 15 years or older with a primary diagnosis of CLL with or without subsequent cancers. A period analysis was performed to estimate the 5- and 10-year relative survival rates for patients diagnosed (dx) during different calendar periods from 1985 to 2017, based on gender and age at time of diagnosis (15–44, 45–54, 55–64, 65–74, 75–84, 85 years or older). A mixture cure model was used to examine the proportion of long-term survivors per gender and age category among CLL patients diagnosed between 1985 and 2015. Cox proportional hazard modeling was used to calculate the hazard ratios (HRs) of death adjusted for gender and age at diagnosis for two cohorts: (a) diagnosed in 2000–2003 and followed to 2012; (b) 2004–2007 and followed to 2015. Results: For males, the 5-year age-adjusted relative survival rate improved progressively from 72.0% (dx 1985-1989) to 88.2% (dx 2010-2014); for females, from 76.8% (dx 1985-1989) to 90.8% (dx 2010-2014). The corresponding 10-year age-adjusted relative survival rates were 47.3% (dx 1985-1989) and 72.5% (dx 2005-2009) for males; and 58.2% (dx 1985-1989) and 78.7% (dx 2005-2009) for females. The table below shows the proportions of long-term survivors for the 1985–2017 cohort as estimated in the mixed cure model. The HRs (95%CI) of death for cohort (b) in comparison to cohort (a) were 0.58 (0.43–0.78), 0.58 (0.48–0.70), 0.57 (0.49–0.67), 0.68 (0.54–0.85); and 0.83 (0.68–1.02) for age categories of 45–54, 55–64, 65–74, 75–84, and 85 years or old. Conclusions: Survival is significantly improved by calendar period among patients diagnosed after 2004 and treated in the era of advanced therapies. Females and younger patients had a higher probability of long term survival. Future studies should consider such covariates as treatment type, disease stage and genetics.[Table: see text]

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Outcomes of Richter’s transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL): an analysis of the SEER database

Annals of Hematology ◽

10.1007/s00277-021-04603-y ◽

2021 ◽

Author(s):

Radowan Elnair ◽

Moataz Ellithi ◽

Avyakta Kallam ◽

Valerie Shostrom ◽

Robert G. Bociek

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Lymphocytic Leukemia ◽

Seer Database ◽

Small Lymphocytic Lymphoma ◽

Richter’S Transformation ◽

Richter's Transformation

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Population Level Outcomes of Chronic Lymphocytic Leukemia in the Era of Targeted Agents- Analysis of Surveillance Epidemiology and End Results (SEER) Database

Blood ◽

10.1182/blood-2019-130211 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 1757-1757

Author(s):

Ravi Kishore Narra ◽

Ehab L. Atallah ◽

Mehdi Hamadani ◽

Guru Subramanian Guru Guru Murthy

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Research Funding ◽

Population Level ◽

Lymphocytic Leukemia ◽

Rank Test ◽

Seer Database ◽

Targeted Agents ◽

Kaplan Meier ◽

Treatment Paradigm ◽

Cox Proportional Hazard Regression

Background: The treatment paradigm of chronic lymphocytic leukemia (CLL) has changed significantly in the last decade with approval of multiple new targeted agents. Small molecule drugs such as ibrutinib, venetoclax, idelalisib and other targeted agents have improved the outcomes of patients with CLL treated in clinical trials. However, it is unclear if the population level outcomes of CLL have improved since the first approval of bruton tyrosine kinase (BTK) inhibitor Ibrutinib in February,2014. Methods: Using SEER database, we identified patients aged ≥ 20 years with pathologically confirmed CLL (ICD-0-3 code 9823/3) diagnosed between 2011-2016 and actively followed. Patients were divided into two groups by the period of diagnosis - 2011-2013, 2014-2016, reflecting the period pre-and post-ibrutinib approval. Overall survival (OS) was compared between the two groups using Kaplan-Meier method and log rank test. Cox proportional hazard regression method was used to determine the influence of period and demographic factors on OS. Statistical analysis was performed with significant two-sided p< 0.05. Results: A total of 30701 patients with a median age of 69 years (range 21-104) were included. Males (60.9%) and White race (80.8%) contributed to the majority as summarized in table 1. Median OS was not reached. OS at 30 months was significantly higher for patients diagnosed from 2014-2016 (83.3%) compared to those diagnosed from 2011-2013 (81.7%) (p=0.004) (figure 1). On multivariate analysis, diagnosis from 2014-2016 (HR 0.90, 95% CI 0.85-0.96, p: 0.002) and females (HR 0.74, 95% CI 0.70-0.78, p< 0.001) had lower mortality risk, whereas, increasing age (HR 1.07, 95% CI 1.07-1.08, p< 0.001), Hispanics (HR 1.18, 95% CI 1.05-1.32, p< 0.004), Non-Hispanic blacks (HR 1.41, 95% CI 1.28-1.54, p< 0.001) had higher risk of mortality. Conclusions: Survival of patients with CLL at the population level is improving since approval of Ibrutinib. Non-biological factors such as age, gender and race/ethnicity continue to influence the survival even in the era of novel agents, highlighting the need for continued research to address these discrepancies. Disclosures Atallah: Jazz: Consultancy; Jazz: Consultancy; Novartis: Consultancy; Pfizer: Consultancy; Helsinn: Consultancy; Helsinn: Consultancy; Takeda: Consultancy, Research Funding. Hamadani:Janssen: Consultancy; Merck: Research Funding; ADC Therapeutics: Consultancy, Research Funding; Pharmacyclics: Consultancy; Takeda: Research Funding; Celgene: Consultancy; Sanofi Genzyme: Research Funding, Speakers Bureau; Medimmune: Consultancy, Research Funding; Otsuka: Research Funding. Guru Murthy:Cardinal Health Inc.: Honoraria.

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