4.2 Article

Survival, causes of death, and the prognostic role of comorbidities in chronic lymphocytic leukemia in the pre-ibrutinib era: A population-based study

Journal

EUROPEAN JOURNAL OF HAEMATOLOGY
Volume 108, Issue 2, Pages 145-153

Publisher

WILEY
DOI: 10.1111/ejh.13720

Keywords

cause of death analysis; chronic lymphocytic leukemia; comorbidities; survival

Categories

Funding

  1. Swedish Blodcancerfonden
  2. Swedish Cancer Society
  3. Stockholm County Council
  4. Karolinska Institutet
  5. Karolinska Institutet Foundations
  6. University of Iceland Research Fund
  7. Icelandic Centre for Research
  8. Landspitali University Hospital Research Fund
  9. Sylvester Comprehensive Cancer Center [P30CA240139]

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In a nationwide study in Sweden, the survival rate of chronic lymphocytic leukemia (CLL) patients improved, partly due to a reduction in CLL-related mortality. Additionally, the mortality rate related to CLL increased in patients with comorbidities, highlighting the importance of newer and more tolerable targeted therapies.
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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