Objective

To evaluate temporal trends in survival and causes of death in patients with chronic lymphocytic leukemia (CLL) in a nationwide study.

Methods

The cohort consisted of 13,009 Swedish CLL patients diagnosed 1982-2013. Relative survival (RS) and excess mortality rate ratios (EMRR) with 95% confidence intervals (95% CIs) were estimated using flexible parametric survival models. Cause-specific hazard ratios (HRs) were estimated for the linear effect of 10-year increase in year of diagnosis.

Results

The excess mortality decreased comparing 2003-2013 to 1982-1992 (EMRR=0.53, 95% CI 0.48-0.58,). The 5-year RS increased between 1982 and 2012 for patients > 51 years at diagnosis and improved for patients ≤ 51 years after 2002. The rate of CLL-specific deaths decreased over time (HR=0.78, 95% CI 0.75-0.81). Compared to patients with no comorbidity, patients with 1 and 2+ Charlson Comorbidity Index points had HR=1.35 (95% CI 1.25-1.45) and HR=1.47 (95% CI 1.37-1.57) for CLL-related mortality, respectively.

Conclusion

Survival in CLL patients improved in the era of chemoimmunotherapy and this was largely explained by reduced CLL-related mortality. The increased rate of CLL-related mortality in patients with comorbidities emphasizes the importance of the newer and better tolerated targeted therapy.