Improved survival in chronic lymphocytic leukemia over two decades: A SEER-based population analysis (2000–2021) Free

Improved Survival in Chronic Lymphocytic Leukemia Over Two Decades: A SEER-Based Population Analysis (2000–2021)

Background: Chronic lymphocytic leukemia (CLL) constitutes the most prevalent variant of leukemia encountered within the adult demographic in the United States. Over the past twenty years, there has been a marked evolution in the landscape of treatment modalities, typified by the incorporation of chemoimmunotherapy in the early 2000s, followed by the advent of targeted therapeutic agents, including Bruton tyrosine kinase (BTK) inhibitors (ibrutinib, acalabrutinib) and BCL2 inhibitors (venetoclax) commencing in the year 2013. We undertook a comprehensive examination of population-level survival trajectories in CLL employing SEER data to evaluate the practical ramifications of these therapeutic advancements across diverse demographic parameters, including age, gender, and ethnicity. Methods: Data regarding relative survival rates were obtained from the SEER Explorer platform and included adults who received a diagnosis of chronic lymphocytic leukemia (CLL) within the timeframe of 2000 to 2021. Relative survival encompasses considerations of background mortality and functions as a measure of cancer-specific survival. Outcomes were evaluated at intervals of 1, 2, and 5 years following the initial diagnosis. Trends were scrutinized across various treatment epochs (pre-2010 versus post-2013), age categories (<65 versus ≥65 years), gender, and primary ethnic groups (White, Black, Hispanic). Results: Among individuals diagnosed with Chronic Lymphocytic Leukemia (CLL) from the year 2000 to 2021, relative survival rates exhibited significant enhancement across all assessed temporal intervals: 1-year: 85.9% 2-year: 81.2% 5-year: 75.4% - Sex disparities: Female patients demonstrated a superior 5-year survival rate (77.3%) in comparison to their male counterparts (73.5%). - Age disparities: Patients below the age of 65 exhibited a 5-year survival rate exceeding 80%, Whereas patients aged 65 years and older experienced survival rates below 70% prior to the year 2010, yet this figure improved to over 74% post-2015. - Ethnic disparities: Caucasian patients reported the highest 5-year survival rate (76.2%), Followed by Hispanic patients at 73.8%, And African American patients at 70.4%. - Impact of treatment era: The 5-year survival rate escalated from 67.2% during the period of 2000–2005 to 78.7% in the interval of 2016–2021, with the most significant advancements observed subsequent to 2013, aligning with the extensive adoption of targeted therapies. Data derived from the FLAIR trial further elucidate these advancements associated with treatment eras. Patients receiving a combination of ibrutinib and venetoclax achieved a 5-year progression-free survival (PFS) rate of 94%, In contrast to 79% with monotherapy utilizing ibrutinib, and Merely 58% with chemoimmunotherapy (FCR). These results underscore the remarkable enhancement in disease management associated with targeted, chemotherapy-free treatment regimens and corroborate the survival improvements noted within the SEER population-level data. Conclusion This investigation grounded in the Surveillance, Epidemiology, and End Results (SEER) program elucidates significant improvements in survival probabilities among patients diagnosed with chronic lymphocytic leukemia (CLL) over the past two decades. These enhancements are intricately associated with the transformative shift in therapeutic approaches from traditional chemoimmunotherapy to targeted agents, which include Bruton tyrosine kinase (BTK) inhibitors and BCL2 antagonists. Notably, the survival advantages noted were uniformly present across various demographic categories, encompassing age, gender, and ethnicity; nevertheless, inequalities remain evident. These findings highlight the substantial impact of novel therapeutic interventions and emphasize the critical need to promote equitable access to these medical innovations among heterogeneous patient populations.