Mortality trends of chronic lymphocytic leukaemia in the United States with the emergence of targeted therapy

Abstract

Chronic lymphocytic leukemia (CLL) accounts for more than one-third of the new cases of leukaemias in the United States. 1 Over the past decades, the treatment landscape for CLL has witnessed significant changes. In the light of the revolutionary progress made in treatment modalities for CLL, we aimed to analyse CLL mortality trends in the past two decades to provide a population-based perspective on the impact of these advancements on patient outcomes and also to identify potential demographic disparities.Death certificate data from the US Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) was analysed from 1999 to 2020 to determine the longitudinal trends of CLL among the US population aged ≥35 years. Those aged below 35 years were excluded due to low case counts. We selected CLL (ICD-10 C91.1) as the underlying cause of death. We measured age-adjusted mortality rates (AAMRs) of CLL per 100 000 individuals by standardizing to the year 2000 US census population. We plotted the AAMRs per 100 000 individuals to determine the trends from 1999 to 2020.There were 97 186 deaths attributed to CLL from 1999 to 2020. Table 1 shows the baseline demographics of patients who met the inclusion criteria. Overall, there was a decrease in the AAMR of CLL from 3.23 (95% CI, 3.13-3.32) per 100 000 individuals in 1999 to 2.05 (95% CI, 1.99-2.11) per 100 000 individuals in 2020, with the average annual percent change (AAPC) at −2.09 (95% CI, −2.69, −1.49). The annual percent change (APC) was greater in the recent decade from 2011 to 2020 than the previous decade from 1999 to 2011 (−3.16 [95% CI, −3.83, −2.84] vs. −1.56 [95% CI, −2.01, −1.11]) (Table 2). Males had a higher AAMR of CLL than females (3.78 [95% CI, 3.75-3.81] vs. 1.72 [95% CI, 1.71-1.74] per 100 000 individuals). The highest AAMR was observed among non-Hispanic White males (4.14 [95% CI, 4.10-4.17] per 100 000 individuals), followed by non-Hispanic Black males (3.48 [95% CI,] per 100 000 individuals), non-Hispanic White females (1.88 [95% CI,] per 100 000 individuals) and non-Hispanic Black females (1.61 [95% CI, 1.55-1.67] per 100 000 individuals) (Figure S1a). Those who lived in the Midwest region and the rural region had the highest AAMR respectively (2.93 [95% CI, 2.89-2.97] per 100 000 individuals vs. 2.87 [95% CI, 2.83-2.91] per 100 000 individuals) (Figure S1b).Our study demonstrates that the AAMR of CLL decreased by 2% annually from 1999 to 2020. This aligns with

Chronic Lymphocytic Leukemia: Management of Adverse Events in the Era of Targeted Agents

“…The small molecule therapies, Bruton Tyrosine Kinase inhibitor (BTKi) and B-cell Lymphoma 2 inhibitor (BCL-2i) target specific and relevant cellular pathways critical to CLL biology which sustain cellular proliferation and survival. TAs have demonstrated superior efficacy with respect to chemo-immunotherapy, in terms of progression-free survival (PFS) and overall survival (OS), in both randomized trials and real-life studies [ 3 , 4 , 5 , 6 , 7 , 8 ].…”