Clinical Characteristics and Outcome of Young Chronic Lymphocytic Leukemia Patients: A Single Institution Study of 204 Cases

Abstract A retrospective analysis on chronic lymphocytic leukemia (CLL) patients ≤55 years observed at a single institution was performed with the purpose of characterizing the clinical features and outcome of young CLL and of identifying patients with different prognostic features. Over the period from 1984 to 1994, 1,011 CLL patients (204 [20%] ≤55 years of age and 807 [80%] >55 years of age) were observed. At diagnosis, younger and older patients displayed a similar distribution of clinical features, except for a significantly higher male/female ratio in younger patients (2.85 v 1.29;P < .0001). Both groups showed an elevated rate of second primary cancers (8.3% v 10.7%), whereas the occurrence of Richter’s syndrome was significantly higher in younger patients (5.9% v 1.2%; P < .00001). Younger and older patients showed a similar overall median survival probability (10 years) but were characterized by a different distribution of causes of deaths: CLL unrelated deaths and second primary malignancies predominated in the older age group, whereas the direct effects of leukemia were prevalent in the younger age group. Although younger and older patients displayed a similar survival, the evaluation of the relative survival rates showed that the disease had a greater adverse effect on the expected survival probability of the younger population. Multivariate analysis showed that for young CLL patients only dynamic parameters, such as lymphocyte doubling time and other signs of active disease, were the independent factors that significantly influenced survival probability (P = .00001). A prolonged clinico-hematologic follow-up allowed us to identify two subsets of young CLL patients with a different prognostic outcome: a group of patients (40%) with long-lasting stable disease without treatment and an actuarial survival probability of 94% at 12 years from diagnosis and another group (60%) with progressive disease and a median survival probability of 5 years after therapy. For the latter patients, the therapeutic effect of innovative therapies with curative intents needs to be investigated in prospective, comparative clinical trials.

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Clinical Characteristics and Outcome of Young Chronic Lymphocytic Leukemia Patients: A Single Institution Study of 204 Cases

Blood ◽

10.1182/blood.v94.2.448.414k13_448_454 ◽

1999 ◽

Vol 94 (2) ◽

pp. 448-454

Author(s):

Francesca R. Mauro ◽

Robert Foa ◽

Diana Giannarelli ◽

Iole Cordone ◽

Sabrina Crescenzi ◽

...

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Clinical Features ◽

Median Survival ◽

Survival Probability ◽

Older Patients ◽

Lymphocytic Leukemia ◽

Second Primary ◽

Age Group ◽

Single Institution ◽

Younger Patients

A retrospective analysis on chronic lymphocytic leukemia (CLL) patients ≤55 years observed at a single institution was performed with the purpose of characterizing the clinical features and outcome of young CLL and of identifying patients with different prognostic features. Over the period from 1984 to 1994, 1,011 CLL patients (204 [20%] ≤55 years of age and 807 [80%] >55 years of age) were observed. At diagnosis, younger and older patients displayed a similar distribution of clinical features, except for a significantly higher male/female ratio in younger patients (2.85 v 1.29;P < .0001). Both groups showed an elevated rate of second primary cancers (8.3% v 10.7%), whereas the occurrence of Richter’s syndrome was significantly higher in younger patients (5.9% v 1.2%; P < .00001). Younger and older patients showed a similar overall median survival probability (10 years) but were characterized by a different distribution of causes of deaths: CLL unrelated deaths and second primary malignancies predominated in the older age group, whereas the direct effects of leukemia were prevalent in the younger age group. Although younger and older patients displayed a similar survival, the evaluation of the relative survival rates showed that the disease had a greater adverse effect on the expected survival probability of the younger population. Multivariate analysis showed that for young CLL patients only dynamic parameters, such as lymphocyte doubling time and other signs of active disease, were the independent factors that significantly influenced survival probability (P = .00001). A prolonged clinico-hematologic follow-up allowed us to identify two subsets of young CLL patients with a different prognostic outcome: a group of patients (40%) with long-lasting stable disease without treatment and an actuarial survival probability of 94% at 12 years from diagnosis and another group (60%) with progressive disease and a median survival probability of 5 years after therapy. For the latter patients, the therapeutic effect of innovative therapies with curative intents needs to be investigated in prospective, comparative clinical trials.

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Long-term survival in chronic lymphocytic leukemia after first primary malignancy in the United States.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18090 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18090-e18090

Author(s):

Amir Bista ◽

Dipesh Uprety ◽

Subash Ghimire ◽

Megha Giri ◽

Binay Kumar Shah

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Relative Survival ◽

The United States ◽

Lymphocytic Leukemia ◽

Second Primary ◽

Age Group ◽

Primary Cancer ◽

Primary Malignancy ◽

Term Survival ◽

Cancer Breast

e18090 Background: There has been significant improvement in survival among patients with primary Chronic Lymphocytic Leukemia (CLL) in recent years but, not much is known about survival among CLL developed after a first primary malignancy. Methods: SEER 18 database, 2015 submission, was used to calculate 5 and 10 year relative survival (RS) by period survival modeling method for 1993 to 2012, with division of the period into 4 cohorts of 5 years each. SEER*Stat software from National Cancer Institute was used to calculate relative survival (RS) for 4 different periods of 5 years duration. The trend in survival for cases with CLL as second primary cancer (CLLSPC) was evaluated using COX proportional hazard method using Cansurv software and also compared with that of primary CLL cases. Results: A total of 8731 patients with CLLSPC were included in the study, which represents 14.5% of all cases of CLL. The median age at diagnosis was 75 years. Median time to diagnosis of CLL was 50 months after diagnosis of first primary malignancy. Prostate cancer, breast cancer and colorectal cancer were 3most common primary cancers. 5-year and 10-year RS improved significantly in the year 2008-2012 compared to 1993-1997 (59.3% to 70.2%,P 0.044 and 40.1% to 50.6%, p 0.045). In subgroup analysis, significant improvement in 5-year and 10-year RS was seen in females and ≥ 80 years age group but no significant improvement was observed in males and age group 60-79 years. Survival among CLLSPC was significant worse compared to first primary CLL in all periods, even after adjusting for age and sex. Conclusions: CLLSPC represents about 14.5% of all CLL cases. Relative survival among patients with CLLSPC is gradually improving but still lags behind that of CLL as first primary cancer.

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Treatment of older patients with chronic lymphocytic leukemia: key questions and current answers

Hematology ◽

10.1182/asheducation-2013.1.158 ◽

2013 ◽

Vol 2013 (1) ◽

pp. 158-167 ◽

Cited By ~ 34

Author(s):

Tait Shanafelt

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Life Expectancy ◽

Elderly Patients ◽

Older Patients ◽

Age At Onset ◽

Lymphocytic Leukemia ◽

Newly Diagnosed ◽

Organ Function ◽

Younger Patients ◽

Key Questions

AbstractDespite the advanced age at onset, chronic lymphocytic leukemia (CLL) shortens the life expectancy of the majority of newly diagnosed patients. The management of elderly patients with CLL is more complex than that of younger patients due to the greater frequency of comorbidities and functional impairment as well as reduced organ function. Many of the recent advances in the care of CLL patients (prognostication, more intense combination therapy regimens) are of unclear relevance for elderly patients. This review addresses 5 key questions in the management of elderly patients with CLL: (1) why is classifying the “fitness” of CLL patients necessary; (2) what criteria should be used to classify patient fitness; (3) when should elderly patients be treated; (4) how should therapy be selected for elderly patients; and (5) which therapy is best (for this patient)?

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Impact of Age on Outcomes After Initial Therapy With Chemotherapy and Different Chemoimmunotherapy Regimens in Patients With Chronic Lymphocytic Leukemia: Results of Sequential Cancer and Leukemia Group B Studies

Journal of Clinical Oncology ◽

10.1200/jco.2011.41.5646 ◽

2013 ◽

Vol 31 (4) ◽

pp. 440-447 ◽

Cited By ~ 44

Author(s):

Jennifer A. Woyach ◽

Amy S. Ruppert ◽

Kanti Rai ◽

Thomas S. Lin ◽

Susan Geyer ◽

...

Keyword(s):

Clinical Trials ◽

Chronic Lymphocytic Leukemia ◽

Older Patients ◽

Progression Free Survival ◽

The Elderly ◽

Initial Therapy ◽

Routine Care ◽

Lymphocytic Leukemia ◽

Age Group ◽

Group B

Purpose Chronic lymphocytic leukemia (CLL) is a disease of the elderly, yet few clinical trials include a significant number of older patients, and outcomes after specific therapies can be different depending on age. Patients and Methods We examined patients enrolled onto successive first-line CALGB CLL trials to determine whether efficacy of regimens varied by age, focusing on ideal chemotherapy choice and benefit of immunotherapy addition to chemotherapy in older patients. Regimens included chlorambucil, fludarabine, fludarabine plus rituximab (FR), fludarabine with consolidation alemtuzumab, and FR with consolidation alemtuzumab. Results A total of 663 patients were evaluated for response, progression-free survival (PFS), and overall survival (OS) by age group. Interaction effects of fludarabine versus chlorambucil by age group (PFS, P = .046; OS, P = .006) showed that among patients younger than 70 years, PFS and OS was improved with fludarabine over chlorambucil (PFS: hazard ratio [HR] = 0.6, 95% CI, 0.5 to 0.8; OS: HR = 0.7, 95% CI, 0.5 to 0.9), but not in older adults (PFS, HR = 1.0, 95% CI, 0.6 to 1.7; OS: HR = 1.5, 95% CI, 0.9 to 2.3). In contrast, FR improved outcomes relative to fludarabine, irrespective of age (PFS: HR = 0.6, 95% CI, 0.4 to 0.7; OS: HR = 0.7, 95% CI, 0.5 to 0.9). Alemtuzumab consolidation did not provide benefit over similar regimens without alemtuzumab (P > .20), irrespective of age. Conclusion These data support the use of chlorambucil as an acceptable treatment for many older patients with CLL and suggest rituximab is beneficial regardless of age. These findings bear relevance to both routine care of CLL patients 70 years and older and also future clinical trials in this population.

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Brief Report: Selected Aspects of Hodgkin’s Disease in a Whole Community

Blood ◽

10.1182/blood.v34.1.91.91 ◽

1969 ◽

Vol 34 (1) ◽

pp. 91-95 ◽

Cited By ~ 5

Author(s):

DINA MEYTES ◽

BARUCH MODAN

Keyword(s):

Median Survival ◽

Hodgkin's Disease ◽

Older Patients ◽

Hodgkin’S Disease ◽

Ethnic Origin ◽

Age Group ◽

Hospital Records ◽

Younger Patients ◽

Significant Difference ◽

Males And Females

Abstract All available hospital records of patients with Hodgkin’s Disease, diagnosed in Israel during a 5-year period were reviewed. A bimodal incidence curve was obtained both for all patients, and for such subcategories as sex and ethnic origin. There was no significant difference in incidence between males and females, nor between various ethnic groups. The frequency of patients presenting with a generalized disease at diagnosis was relatively higher in males and in older patients of both sexes. The median survival was 27 months with a considerably better prognosis in younger patients of both sexes and in females younger than 45, as compared to males of the same age group. Lymphocytopenic males had a shorter survival course, but no such pattern was evident among females.

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Results of the Hyper-CVAD Regimen in Elderly Acute Lymphocytic Leukemia (ALL)

Blood ◽

10.1182/blood.v112.11.3954.3954 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3954-3954

Author(s):

Susan O’Brien ◽

Deborah Thomas ◽

Farhad Ravandi-Kashani ◽

Stefan Faderl ◽

Sherry Pierce ◽

...

Keyword(s):

Older Patients ◽

Causes Of Death ◽

Treatment Strategies ◽

Study Groups ◽

Lymphocytic Leukemia ◽

P Value ◽

Age Group ◽

Younger Patients ◽

Low Intensity ◽

Improve Treatment

Abstract Background. Understanding the causes of failure in older patients with ALL may help improve treatment strategies for this age group. Study Aims. To define the causes of death in older (age ≥60 years) patients with ALL during induction and consolidation-maintenance with the dose intensive Hyper-CVAD regimen, and compare their outcome to those of older patients treated previously with less intensive regimens, and to those of younger patients treated with Hyper-CVAD. Study Groups. 122 older patients treated with Hyper-CVAD were compared with 34 older patients treated with less intensive regimens, and 409 younger patients treated with Hyper-CVAD. Results. The outcome in older patients on Hyper-CVAD, older patients on other regimens, and younger patients on Hyper-CVAD are shown in the Table. Conclusion. Intensifying the chemotherapy in older patients with ALL reduced the incidence of leukemia resistance but increased the incidence of death in CR from myelosuppression-associated infections. The overall benefit: risk was favorable. Identifying novel low-intensity agents/regimens for older patients with ALL may improve the results. Parameter Older; Hyper CVAD Older; Other Younger; Hyper CVAD P value Most deaths during induction and in CR were related to infections Number 122 34 409 % CR 84 59 92 <0.001 % Induction mortality 10 12 2 NS for older % Resistance 5 27 2 <0.001 % Death in CR 34 15 7 <0.001 % Relapse 40 80 48 0.004 % 5-year survival 20 9 48 <0.001

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