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Patients with CML have life expectancy comparable to that of general population
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New tyrosine kinase inhibitors with allogeneic stem cell transplantation have prolonged the life expectancy of patients with chronic myeloid leukemia to approach that of general population, according to the results population-based study conducted in Sweden.
“The results indicated that a recent diagnosis of CML reduced the life expectancy, on average, by less than 3 years,” Hannah Bower, MSc, a PhD student in the department of medical epidemiology and biostatistics at Karolinska Institutet in Stockholm, Sweden, told HemOnc Today. “We knew that there had been vast improvement in survival of patients with CML due to the great treatment developments, but we were not sure how this translated into improvements in the life expectancy.”
Hannah Bower
The introduction of the TKI imatinib caused a dramatic survival improvement for patients in CML, particularly those with chronic-phase disease.
“Treatment with imatinib mesylate began in Sweden in 2001, resulting in major survival improvements, with the exception of the old/very elderly,” Bower said.
Increased survival and need for lifelong imatinib treatment will have an impact on costs, and information regarding these statistics is important for health care professionals, educators and policy makers. Thus, Bower and colleagues evaluated how the life expectancy of patients with CML aged older than 50 years changed between 1973 and 2013, and whether previously reported survival improvements persisted between 2008 and 2013.
Researchers used the Swedish Cancer Registry to identify 2,662 patients (54.3% male; median age at diagnosis, 69 years) diagnosed with CML between 1973 and 2013 who they followed until death, censorship or end of follow-up period. Researchers used a flexible parametric relative survival model to predict life expectancy and loss in expectation of life — a survival measure that presents the number of life-years lost or reduction in life expectancy as a result of a cancer diagnosis.
Patients were evaluated based on age at diagnosis (55 years, 65 years, 75 years or 85 years) and compared with the general population at four time points (1980, 1990, 2000 and 2010).
Life expectancy increased steadily for all patients with CML between 1973 and 1990, especially among younger patients. The greatest increases occurred between 1990 and 2000, with a steady increase occurring thereafter. By 2013, the life expectancy of patients with CML approached that of the general population.
On average, a man diagnosed with CML at age 55 years would have had 3.5 (95% CI, 2.9-4.1) years of life remaining if he was diagnosed in 1980 compared with 27.3 (95% CI, 25.7-28.8) years if he was diagnosed in 2010.
For a man aged 85 years at diagnosis, the life years remaining increased from 0.8 (95% CI, 0.7-1.1) in 1980 to 4.1 (95% CI, 3.4-4.7) in 2010.
In 2010, the life expectancy for men and women with CML was within 3 years of the expectancy of the general public in all age categories.
Results also showed that the loss in expectation of life fell dramatically for all ages during the study period, but especially among younger patients who received a diagnosis after 1990.
On average, a man aged 55 years diagnosed in 1980 would lose 20.8 (95% CI, 20.2-21.4) years of life, whereas a man of the same age diagnosed in 2010 would lose 2.6 (95% CI, 1.0-4.1) years.
Improvements also were seen among older patients with CML; however, because older patients have fewer potential life-years remaining, these decreases were not as dramatic.
Bower and colleagues acknowledged that the Swedish Cancer Registry does not contain detailed clinical information on treatment, socioeconomic factors and other areas, which may have limited findings.
“[These data] further confirm the progress that has been seen in the treatment of patients with CML over time,” Bower said. “We hope that this study and its understandable methods are helpful in communicating what patients are expected to experience after a diagnosis of CML. It would be interesting to use more detailed registries, such as the Swedish CML registry, to identify and quantify causal relationships.” – by Nick Andrews
Disclos ure: Bower reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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