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. 2018 Oct 1;124(19):3856-3867.
doi: 10.1002/cncr.31674. Epub 2018 Oct 21.

Adult leukemia survival trends in the United States by subtype: A population-based registry study of 370,994 patients diagnosed during 1995-2009

Chris Bailey  1 , Lisa C Richardson  2 , Claudia Allemani  1 , Audrey Bonaventure  1 , Rhea Harewood  1 , Angela R Moore  2 , Sherri L Stewart  2 , Hannah K Weir  2 , Michel P Coleman  1 ; CONCORD Working Group (US members)
Affiliations

Adult leukemia survival trends in the United States by subtype: A population-based registry study of 370,994 patients diagnosed during 1995-2009

Chris Bailey et al. Cancer. .

Abstract

Background: The lifetime risk of developing leukemia in the United States is 1.5%. There are challenges in the estimation of population-based survival using registry data because treatments and prognosis vary greatly by subtype. The objective of the current study was to determine leukemia survival estimates in the United States from 1995 to 2009 according to subtype, sex, geographical area, and race.

Methods: Five-year net survival was estimated using data for 370,994 patients from 43 registries in 37 states and in 6 metropolitan areas, covering approximately 81% of the adult (15-99 years) US population. Leukemia was categorized according to principal subtype (chronic lymphocytic leukemia, acute myeloid leukemia, and acute lymphocytic leukemia), and subcategorized in accordance with the HAEMACARE protocol. We analyzed age-standardized 5-year net survival by calendar period (1995-1999, 2000-2004, and 2005-2009), leukemia subtype, sex, race, and US state.

Results: The age-standardized 5-year net survival estimates increased from 45.0% for patients diagnosed during 1995-1999 to 49.0% for those diagnosed during 2000-2004 and 52.0% for those diagnosed during 2005-2009. For patients diagnosed during 2005-2009, 5-year survival was 18.2% (95% confidence interval [95% CI], 17.8%-18.6%) for acute myeloid leukemia, 44.0% (95% CI, 43.2%-44.8%) for acute lymphocytic leukemia, and 77.3% (95% CI, 76.9%-77.7%) for chronic lymphocytic leukemia. For nearly all leukemia subtypes, survival declined in successive age groups above 45 to 54 years. Men were found to have slightly lower survival than women; however, this discrepancy was noted to have fallen in successive calendar periods. Net survival was substantially higher in white than black patients in all calendar periods. There were large differences in survival noted between states and metropolitan areas.

Conclusions: Survival from leukemia in US adults improved during 1995-2009. Some geographical differences in survival may be related to access to care. We found disparities in survival by sex and between black and white patients.

Keywords: Epidemiology; National Program of Cancer Registries; Surveillance; United States; and End Results (SEER); cancer; cancer registries; leukemia; population-based survival.

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Conflict of interest statement

Additional supporting information may be found online in the Supporting Information section at the end of the article.

CONFLICT OF INTEREST DISCLOSURES

The authors made no disclosures.

Figures

Figure 1.
Figure 1.
Participating registries in the analysis of leukemia survival trends in the United States, 1995–2009. †Surveillance, Epidemiology, and End Results registries; *National Program of Cancer Registries (bold); Metropolitan registries (italics).
Figure 2.
Figure 2.
The absolute age-standardized 5-year net survival difference (shown as percentage) in principal groups between black (B), white (W), and other (O) races for leukemias in the United States, 1995–2009. The boxes represent the absolute difference between B and W races. Point estimates for B, W, and O races are shown on the x-axis. The 95% confidence intervals for W and B patients are shown by error bars. ALL indicates acute lymphocytic leukemia; AML, acute myeloid leukemia; CLL, chronic lymphocytic leukemia.
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