Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Nov 11;6(11):e499.
doi: 10.1038/bcj.2016.105.

Improved survival for patients diagnosed with chronic lymphocytic leukemia in the era of chemo-immunotherapy: a Danish population-based study of 10455 patients

C da Cunha-Bang  1 , J Simonsen  2 , K Rostgaard  2 , C Geisler  1 , H Hjalgrim  1   2 , C U Niemann  1
Affiliations

Improved survival for patients diagnosed with chronic lymphocytic leukemia in the era of chemo-immunotherapy: a Danish population-based study of 10455 patients

C da Cunha-Bang et al. Blood Cancer J. .

Abstract

The treatment of chronic lymphocytic leukemia (CLL) is in rapid transition, and during recent decades both combination chemotherapy and immunotherapy have been introduced. To evaluate the effects of this development, we identified all CLL patients registered in the nation-wide Danish Cancer Register between 1978 and 2013. We identified 10 455 CLL patients and 508 995 CLL-free control persons from the general population. Compared with the latter, the relative mortality rate between CLL patients and their controls decreased from 3.4 (95% CI 3.2-3.6) to 1.9 (95% CI 1.7-2.1) for patients diagnosed in 1978-1984 and 2006-2013, respectively. The improved survival corresponded to a decreasing risk of death from malignant hematological diseases, whereas the risk of death from infections was stable during the study period. These population-based data substantiate the improved survival for patients treated with chemo-immunotherapy demonstrated in clinical studies.

PubMed Disclaimer

Conflict of interest statement

CUN received consultancy fees/support outside the current study from Roche, Abbvie, Janssen, Gilead and Novartis; CG received consultancy fees from Sanofi, Celgene and Janssen and consultancy and advisory board fees from Roche outside the current study. The remaining authors declare no conflicts of interests.

Figures

Figure 1
Figure 1
Overview of the guidelines for the management of CLL during the study period. Based on published studies with implications on the treatment in Denmark, national guidelines and market authorization for specific drugs., ,
Figure 2
Figure 2
Survival from the time of CLL diagnosis. Survival probability for patients diagnosed with CLL (cases) and age, gender and region of residence matched background population (controls). Patients were categorized according to calendar period (1978–1984, 1985–1991, 1992–1998, 1999–2005 and 2006–2013) and age (under 64 (<64), from 65 to 74 or over 75 (⩾75)) years at the time of diagnosis. Cases and controls are plotted using full and dotted lines, respectively.
Figure 3
Figure 3
Mortality rate ratios according to calendar period of CLL diagnosis. The hazard rate ratio for death for patients diagnosed with CLL versus age, region of residence and gender matched background population. Patients were categorized according to calendar period (1978–1984, 1985–1991, 1992–1998, 1999–2005 and 2006–2013) of diagnosis.
Figure 4
Figure 4
Cause of death according to calendar period and age at the time of CLL diagnosis. Cause-specific mortality for patients diagnosed with CLL versus age, gender and region of residence matched background population. Patients were categorized according to calendar period of diagnosis (1978–1984, 1985–1991, 1992–1998, 1999–2005 and 2006–2013) and age (under 64 (<64), from 65 to 74 and above 75 (⩾75)) at the time of diagnosis. Cause of death was categorized as hematological/lymphatic malignancy, other malignancies, cardiovascular disease, cerebrovascular disease, infection and other. Only underlying cause of death was included, except for infection where both contributory and underlying cause of death were included. Thus, infection as contributory or underlying cause of death overrules other underlying causes of death, each patient/control person only counted once. CLL patients are plotted using full color bars, matched background control using dashed bars.
See this image and copyright information in PMC

References

    1. Howlader N, Ries LA, Mariotto AB, Reichman ME, Ruhl J, Cronin KA. Improved estimates of cancer-specific survival rates from population-based data. J Natl Cancer Inst 2010; 102: 1584–1598. - PMC - PubMed
    1. Hallek M, Cheson BD, Catovsky D, Caligaris-Cappio F, Dighiero G, Dohner H et al. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute-Working Group 1996 guidelines. Blood 2008; 111: 5446–5456. - PMC - PubMed
    1. Wierda WG, O'Brien S, Wang X, Faderl S, Ferrajoli A, Do KA et al. Prognostic nomogram and index for overall survival in previously untreated patients with chronic lymphocytic leukemia. Blood 2007; 109: 4679–4685. - PubMed
    1. Döhner H, Stilgenbauer S, Benner A, Leupolt E, Kröber A, Bullinger L et al. Genomic aberrations and survival in chronic lymphocytic leukemia. New Engl J Med 2000; 343: 1910–1916. - PubMed
    1. Bahlo J. The International Prognostic Index For Patients With Chronic Lymphocytic Leukaemia (CLL-IPI) - an international meta-analysis. Hematol Oncol 2015; 33: 100–180.

Publication types

LinkOut - more resources