Major Improvements in Survival in Hematologic Malignancies in the Early 2000s.
Authors: Pulte Dianne , Gondos Adam , Brenner Hermann 
Published: October 2019

Abstract
Background: Recent advances in the treatment of hematologic malignancies have led to improvements in response and survival in clinical trials for several conditions. Translation of these improvements to better survival on the population level should be monitored in as timely as possible a manner.
Methods: We estimated trends in relative survival in patients with common hematologic malignancies in the United States between the years 2000 and 2004 using data from the Surveillance, Epidemiology, and End Results (SEER) program, employing the recently introduced technique of modeled period analysis to provide the most up-to-date and precise estimates of survival1. We calculated survival according to gender and age group as well as overall survival for each malignancy.
Results: Major improvements in 5-year relative survivals were observed for nodal and extra-nodal non-Hodgkin lymphoma (NHL) (+8.3 and +7.1 percentage points, respectively, p<0.0001), acute myeloblastic leukemia (AML) (+4.8 percentage points, p=0.005), and chronic myelocytic leukemia (CML) (+15.9 percentage points, p<0.0001). Improvement in 10-year survivals were observed in nodal and extra-nodal (EN) NHL (+8.7 and +7.8 percentage points, p<0.0001), AML (+4.3 percentage points, p=0.009), CML (+16.2 percentage points, p<0.0001), and myeloma (+3.4 percentage points, p=0.01). Statistically significant improvements in 10-year survival were seen in both genders for NHL and CML, but were limited to women for MM and AML, although a trend towards improved survival was seen in men with these conditions as well. Improvements in prognosis were largely restricted to patients aged less than 65, except for NHL and CML. Patients over 65 with EN NHL actually had a greater improvement than younger patients, with increases of 6.0 and 8.5 percentage points, respectively for patients over and under 65. The single greatest improvement observed was in patients less than 65 with CML, who had a 25.2 percentage point improvement in 10-year relative survival between 2000 and 2004.
Conclusions: Application of modeled period analysis to an examination of hematologic malignancies revealed profound improvements in survival in the 5 years between 2000 and 2004. Survival in CML has improved dramatically, and major improvements were also seen for survival in NHL, AML, and MM. A combination of new therapeutic options, improved supportive care, and wider application of recent advances is likely to be responsible for the improvements observed. Our results emphasize the importance of timely information about translation of therapeutic advances into clinical practice, such as can be provided by modeled period analysis. 1. Brenner H, Hakulinen T. Up-to-date and precise estimates of cancer patient survival: model-based period analysis. Am J Epidemiol.2006;164:689–696.
10-year survival in hematologic malignanices in 2000 and 2004 Malignancy Number 10-year survival (SE)-2000 10-yr survival (SE)-2004 Difference P-value HD 9989 78.3 (1.2) 81.8 (1.1) +3.5 0.12 NHL-nodal 40,121 45.4 (0.9) 54.1 (0.9) +8.7 <0.0001 NHL-EN 19,447 60.1 (1.4) 67.9 (1.3) +7.8 0.00015 MM 17,330 14.3 (0.9) 17.7 (1.0) +3.4 0.01 ALL 2222 26.5 (2.8) 33.2 (2.9) +6.7 0.14 CLL 12,881 54.2 (2.0) 56.6 (2.0) +2.4 0.45 AML 10,153 15.0 (1.0) 19.3 (1.2) +4.3 0.0085 CML 5308 22.4 (2.0) 38.6 (2.4) +16.2 <0.0001