Determinants of survival in patients with chronic myeloid leukaemia treated in the new era of oral therapy: findings from a UK population-based patient cohort

Abstract

Objectives: To examine contemporary survival patterns in the general population of patients diagnosed with chronic myeloid leukaemia (CML), and to identify patient groups with less than optimal outcomes.

Design: Prospective population-based cohort.

Setting: The UK's Haematological Malignancy Research Network (catchment population 3.6 million, with >2000 new haematological malignancies diagnosed annually).

Participants: All patients newly diagnosed with CML, from September 2004 to August 2011 and followed up to 31 March 2013.

Main outcome measure: Incidence and survival.

Results: With a median diagnostic age of 59 years, the CML age standardised (European) incidence was 0.9/100 000 (95% CIs 0.8 to 0.9), 5-year overall survival was 78.9% (72.3 to 84.0) and 5-year relative survival 88.6% (81.0 to 93.3). The efficacy of treatment across all ages was clearly demonstrated; the relative survival curves for those under 60 and over 60 years being closely aligned. Survival findings were similar for men and women, but varied with deprivation; the age and sex adjusted HR being 3.43 (1.89 to 6.22) for deprivation categories 4-5 (less affluent) versus 1-3 (more affluent). None of these differences were attributable to the biological features of the disease.

Conclusions: When therapy is freely provided, population-based survival for CML is similar to that reported in clinical trials, and age loses its prognostic significance. However, although most of the patients with CML now experience close to normal lifespans, those living in more deprived areas tend to have poorer outcomes, despite receiving the same clinical care. A significant improvement in overall population outcomes could be achieved if these socioeconomic differences, which may reflect the treatment compliance, could be eliminated.

Keywords: Chronic myeloid leukaemia; Drug compliance; EPIDEMIOLOGY; Socio-economic status.

Figure 1

Crude (A) and relative (B) survival of the 242 patients diagnosed with CML in HMRN.

Figure 2

Crude (A, C, E) and relative survival (B, D, F) of the 234 patients diagnosed within HMRN 2004 to 2011 (deaths 2004 to 20 13) who were treated with tyrosine kinase inhibitors by age at diagnosis (A, B), Sex (C, D) and deprivation (E, F).