Changes in Survival of Older Patients with Hematologic Malignancies in the Early 21st Century

Background: Survival expectations for patients with hematologic malignancies have improved in the early 21^st century. However, survival for older patients remains low and prior studies have not demonstrated as robust an improvement for older patients as for younger patients. Newer, less toxic treatments for several hematologic malignancies have allowed improved survival in older patients in clinical trials. Here, we examine survival for older patients with hematologic malignancies in the early 21^st century to determine whether survival has changed over this time period.

Methods: Patients over age 65 with a common hematologic malignancy were identified from the Surveillance, Epidemiology, and End Results (SEER) 13 database for the periods 1997-2000, 2001-2004, 2005-2008, and 2009-2012. Malignancies examined included acute lymphoblastic leukemia (ALL), acute myeloblastic leukemia (AML), chronic lymphocytic leukemia (CLL), chronic myelocytic leukemia (CML), Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL), and myeloma. Five-year relative survival for each malignancy was calculated using period analysis. For comparison, 5-year relative survival for patients age 50-59 was evaluated as well.

Results: Survival expectations were lower for patients age 65 and older than for younger patients with a given hematologic malignancy and survival expectations decreased with age. Five year relative survival increased between 1997-2000 and 2009-12 for all hematologic malignancies. However, for AML and ALL, the increase was limited to patients age 65-74. Five year relative survival estimates increased for all age groups, including 85+, for HL, CML, NHL, CML, and myeloma (Table 1). Five-year relative survival for patients age 85+ increased by 39.6, 11.6 and 31.5 percent units for CLL, myeloma, and NHL, respectively between 1997-2002 and 2009-12.

Conclusions: Survival for older patients with hematologic malignancies remains low compared to survival for younger patients. However, survival for older patients has increased in the early 21^st century, possibly due to less toxic therapeutic options and improved supportive care, with the greatest improvement observed for NHL , CLL, and CML. Survival remains poor for older patients with acute leukemia, especially in the “oldest old” age group.

 

Cancer site	Age at diagnosis	5-year relative survival (standard error)
		1997-2000	2009-2012	Difference (% units)
AML	50-59	21.4 (1.7)	35.0 (1.7)	+13.6
	65-69	6.6 (1.1)	15.6 (1.7)	+9.0
	70-74	4.1 (0.8)	8.1 (1.2)	+4.0
	75-79	3.2 (0.8)	3.4 (0.8)	+0.2
	80-84	0.4 (0.3)	0.4 (0.4)	0.0
	85+	0.6 (0.4)	0.4 (0.4)	-0.2
CML	50-59	46.7 (2.9)	80.4 (2.1)	+33.7
	65-69	35.2 (3.1)	56.7 (3.5)	+21.5
	70-74	16.8 (2.2)	48.2 (3.6)	+31.4
	75-79	13.6 (2.1)	38.4 (3.4)	+24.8
	80-84	6.4 (1.5)	28.7 (3.6)	+22.3
	85+	5.7 (1.7)	18.7 (3.9)	+13.0
ALL	50-59	24.5 (4.2)	30.2 (3.8)	+5.7
	65-74	5.5 (2.0)	19.1 (3.8)	+13.6
	75+	2.8 (1.9)	10.6 (3.6)	+7.8
CLL	50-59	80.8 (1.4)	92.0 (1.0)	+11.2
	65-69	67.0 (1.7)	84.7 (1.5)	+17.7
	70-74	60.9 (1.6)	83.1 (1.6)	+22.2
	75-79	49.1 (1.7)	80.5 (1.9)	+31.4
	80-84	35.9 (1.9)	71.3 (2.4)	+35.4
	85+	17.6 (1.5)	57.2 (3.2)	+39.6
Myeloma	50-59	42.2 (1.6)	58.9 (1.3)	+16.7
	65-69	27.8 (1.4)	54.7 (1.6)	+26.9
	70-74	24.6 (1.3)	39.8 (1.5)	+15.2
	75-79	20.4 (1.2)	41.5 (1.8)	+21.1
	80-84	13.4 (1.2)	28.5 (1.7)	+15.1
	85+	5.5 (0.9)	17.1 (2.0)	+11.6
NHL	50-59	63.7 (0.8)	78.1 (0.6)	+14.4
	65-69	50.8 (0.9)	73.0 (0.9)	+22.2
	70-74	45.8 (0.9)	68.6 (1.0)	+22.8
	75-79	35.8 (0.9)	62.7 (1.1)	+26.9
	80-84	27.2 (0.9)	55.1 (1.3)	+27.9
	85+	13.3 (0.8)	44.8 (1.6)	+31.5
HL	50-59	71.3 (2.3)	80.7 (1.9)	+9.4
	65-74	49.8 (2.9)	66.2 (2.9)	+16.4
	75+	23.0 (2.5)	45.9 (3.5)	+22.9