Background: Five year survival has increased dramatically for most of the common hematologic malignancies in the early part of the 21st century, probably due to new therapeutic options. However, less is known about the effects recent changes in therapy have had on longer term survival. Here, we examine 10- and 20-year survival for patients with common hematologic malignancies including myeloma, acute lymphoblastic leukemia (ALL), acute myeloblastic leukemia (AML), chronic lymphoid leukemia (CLL), chronic myeloid leukemia (CML), non-Hodgkin lymphoma (NHL), and Hodgkin lymphoma (HL).
Methods: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER9) database. Patients age 15+ with appropriate ICD-10 codes for the above malignancies were included, with exclusion of those patients diagnosed by death certificate only. The boomerang method1 was used to estimate 10 and 20-year relative survival for patients in two calendar periods, 1999-2003 and 2009-13. This recently described method has been demonstrated to more closely approximate actual observed survival for a given time period compared to other methods of estimation, including period analysis, by minimizing the contribution of earlier time periods to the estimation of survival.
Results: Ten and 20-year survival increased for each malignancy examined, with increases ranging from +4.3 percent units for 20-year survival for myeloma to +28.4 percent units for 10-year survival for CML (see Table). Ten year relative survival was greater than 50% in 2009-13 for patients with CML, CLL, NHL, and HL, at 69.9%, 59.1%, 63.4%, and 63.1%, respectively. Major decreases in survival were observed between 10- and 20-year survival estimates for all malignancies except for AML, where 10- and 20-year relative survival estimates were virtually identical in 2009-13.
Discussion: Long term survival is increasing for common hematologic malignancies, with particularly strong increases being observed for CLL, CML, and NHL. Major decreases in survival were observed between 10 and 20 years for most malignancies, including NHL and ALL, which are generally considered curable. This may be partly due to the effect of recent changes in therapy leading to underestimation of 20-year survival, even using the boomerang method, but further study of long-term outcomes in curable malignancies to determine whether there is an increased risk of specific issues later in life is indicated.
1. Brenner H, Jansen L. Timely disclosure of progress in long-term cancer survival: the boomerang method substantially improved estimates in a comparative study. J Clin Epidemiol. 2016;70:224-32.
Pulte:Selexys Pharmaceuticals: Research Funding; EBSCO: Other: Review of content for Dynamed medical reference product; ApoPharma: Research Funding.
Asterisk with author names denotes non-ASH members.