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CHRONIC MYELOGENOUS LEUKEMIA

Conditional relative survival among adult patients with chronic myeloid leukemia in the tyrosine kinase inhibitor era: a population-based study in the Netherlands

Leukemia volume 35, pages 3291–3294 (2021)Cite this article

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From an often fatal to a chronic malignancy, this connotation surrounds chronic myeloid leukemia (CML) since the first-generation tyrosine kinase inhibitor (TKI) imatinib was introduced for its management in the early-2000s [1]. However, recent population-based studies show a different picture. Excess mortality in CML remains an issue in the TKI era, especially in countries with health inequities related to the provision and monitoring of TKI therapy, and older age groups [2,3,4]. Notwithstanding, the effectiveness of imatinib and subsequent generations of commercially available TKIs brought about many long-term CML survivors [5]. In this context, survival statistics measured from diagnosis might not be relevant to inform long-term CML survivors and their care providers about changes in CML prognosis over time. Conditional survival is an appropriate measure in this respect to estimate the survival probability after having survived several years after diagnosis [6, 7]. However, statistics on conditional relative survival (CRS)—which is the conditional survival corrected for the life expectancy of comparable groups from the general population—are lacking among CML patients diagnosed and managed in a contemporary TKI era. Therefore, in this nationwide, population-based study, we assessed 5-year relative survival (RS) at diagnosis and for each additional year survived up to 10 years post diagnosis (that is, 5-year CRS) among adult CML patients diagnosed in the TKI era in the Netherlands.

We selected all CML patients aged ≥18 years diagnosed between 2001 and 2018—with survival follow-up through December 31, 2019—from the Netherlands Cancer Registry (NCR) using International Classification of Diseases for Oncology morphology codes 9863 and 9875. Five patients diagnosed at autopsy were excluded. The NCR has nationwide coverage of >95% of all malignancies in the Netherlands since 1989 [8]. The decision to start the study period from 2001 was based on the introduction of imatinib into routine clinical practice in the Netherlands from that year onward [2]. Of note, subsequent generations of TKIs were routinely prescribed in the Netherlands as of 2009 [2]. Further details about the NCR concerning CML are described elsewhere [2]. The Privacy Review Board of the NCR approved the use of anonymous data for this study.

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Fig. 1: Conditional 5-year relative survival up to 10 years post-diagnosis among adult patients with chronic myeloid leukemia in the Netherlands.

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Acknowledgements

The authors would like to thank the registration clerks of the Netherlands Cancer Registry (NCR) for their dedicated data collection. The nationwide population-based NCR is maintained and hosted by the Netherlands Comprehensive Cancer Organisation (IKNL).

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Authors and Affiliations

  1. Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands

    Geneviève I. C. G. Ector & Nicole M. A. Blijlevens

  2. Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands

    Geneviève I. C. G. Ector & Avinash G. Dinmohamed

  3. Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands

    Otto Visser

  4. Department of Internal Medicine, Reinier de Graaf Group, Delft, The Netherlands

    Eduardus F. M. Posthuma

  5. Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands

    Eduardus F. M. Posthuma

  6. Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands

    Peter E. Westerweel

  7. Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands

    Jeroen J. W. M. Janssen & Avinash G. Dinmohamed

  8. Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands

    Avinash G. Dinmohamed

  9. Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands

    Avinash G. Dinmohamed

Authors
  1. Geneviève I. C. G. Ector
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  2. Otto Visser
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  6. Nicole M. A. Blijlevens
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  7. Avinash G. Dinmohamed
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Contributions

AGD designed the study; GICGE analyzed the data; AGD supervised the data analyses; OV was responsible for the data collection; GICGE wrote the manuscript with contributions from all authors, who also interpreted the data, and read, commented on, and approved the final version of the manuscript.

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Correspondence to Geneviève I. C. G. Ector.

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Ector, G.I.C.G., Visser, O., Posthuma, E.F.M. et al. Conditional relative survival among adult patients with chronic myeloid leukemia in the tyrosine kinase inhibitor era: a population-based study in the Netherlands. Leukemia 35, 3291–3294 (2021). https://doi.org/10.1038/s41375-021-01174-9

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