Population-Level Outcomes of Pediatric Acute Promyelocytic Leukemia in the United States.

OBJECTIVE: To determine whether the population level outcomes of pediatric acute promyelocytic leukemia have improved over time. STUDY DESIGN: We conducted a retrospective analysis of the Surveillance Epidemiology and End Results database for patients with acute promyelocytic leukemia, up to 20 years of age, diagnosed between 1976 and 2016 and actively followed. Patients were stratified based on their period of diagnosis (1976-1989, 1990-1999, 2000-2009, 2010-2016) to assess the temporal trends in overall survival and early mortality. RESULTS: A total of 553 patients with a median age of 15 years (range, 0-20 years) were included. The 5-year overall survival increased significantly over time (by 22.6% from 1976 to 1989; by 59.2% from 1990 to 1999; by 77.7% from 2000 to 2009; and by 88.9% from 2010 to 2016; P < .001). Early mortality showed an improvement over time in the most recent cohort (by 14% from 1976 to 1989; by 13.5% from1990 to 1999; by 13.3% 2000 to 2009; and by 7.2% from 2010 to 2016) after adjusting for other demographic characteristics in a logistic regression model. On multivariate analysis of overall survival, diagnosis in the earlier time periods was associated with higher mortality as compared with the 2010-2016 period. Age, sex, and race/ethnicity were not significant predictors of overall survival. CONCLUSIONS: Outcomes of pediatric acute promyelocytic leukemia have continued to improve over time at the population level.

Trends in survival outcomes of B-lineage acute lymphoblastic leukemia in elderly patients: analysis of Surveillance, Epidemiology, and End Results database.

B-lineage acute lymphoblastic leukemia (B-ALL) in the elderly population is generally considered to have a poor prognosis. It is unclear whether their survival has improved in the current era. Using the Surveillance, Epidemiology, and End Results database, we selected 717 elderly patients (age≥60) with B-ALL diagnosed between 1992 and 2011. Overall survival (OS) was compared based on their period of diagnosis and age. Patients in the age group 60-69 had an improvement in OS over time, both 1-year OS (49.4% in 2002-2011 vs. 33.1% in 1992-2001) and 5-year OS (20.4% in 2002-2011 vs. 8.1% in 1992-2001, p=0.002). Patients≥70 years had no significant improvement in 1-year OS or 5-year OS (5-year OS 5.5% in 1992-2001 vs. 9.7% in 2002-2011, p=0.326). Hence, there are discrepancies in the improvement of OS among elderly patients with B-ALL. Further focus of research in elderly patients with B-ALL is needed to improve their outcome.

Effect of radiotherapy on the survival of patients with stage I and stage II mantle cell lymphoma: analysis of the Surveillance, Epidemiology and End Results database.

BACKGROUND: Radiotherapy is a treatment option for stage I and stage II MCL. However, data demonstrating the role of RT in a larger patient population and its real world effects are unknown. MATERIALS AND METHODS: To demonstrate the role of RT in the OS of patients with stage I and stage II MCL, we performed a retrospective analysis of the SEER database. Included patients were adults with age > 40 years who had MCL stages I and II, and diagnosis between 1992 and 2010. We excluded patients lacking information on demographic characteristics, survival, and RT. Patients were analyzed in 2 groups, those treated with initial RT (RT group) and those not treated with initial RT (no-RT group). RESULTS: A total of 657 patients were eligible for analysis with 178 patients in the RT group and 479 patients in the no-RT group. The median age of the study group was 68 years. The RT group had a significantly greater proportion of patients with age < 60, male sex, and extranodal disease. Median OS was 103 months in the RT group versus 66 months in the no-RT group (P = .002). On Multivariate analysis, treatment with initial RT was associated with a lower hazard for mortality (hazard ratio, 0.767; 95% confidence interval, 0.602-0.979; P = .033). Age < 60, stage I disease, and extranodal disease were independently associated with a significantly decreased hazard for mortality on Multivariate analysis. CONCLUSION: Although stage I and stage II MCL constitute only a small proportion of this disease, our study demonstrates that upfront RT improves the OS of these patients.