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PROTEOMICS MARKERS PROGNOSTIC FOR OUTCOME OF CHRONIC LYMPHOCYTIC LEUKEMIA PATIENTS UNDER TREATMENT: RESULTS FROM THE HOVON‐109 STUDY

between 1989-2016 (median age 69 years; range 21-101 years; 61% males; 11% with a prior malignancy) from the Netherlands Cancer Registry, with follow-up for survival through January, 2018. Patients were categorized into four periods (1989-1995, 1996-2002, 2003-2008, and 2009-2016) and four age groups (18-59, 60-69, 70-79, and ≥80 years). Age-standardized incidence rates (ASRs) were calculated per 100,000 person-years and standardized according to the European standard population. Relative survival (RS) was calculated as a measure of disease-specific survival. Multivariable evaluation of RS was performed using Poisson regression with adjustment for period of diagnosis, sex, age at diagnosis, and a prior malignancy before CLL diagnosis. Results: The annual ASR of CLL initially increased gradually since 1989; however, the overall incidence pattern subsequently stabilized at around 4.0 to 4.5 as from 2003. The overall ASR was consistently higher among males than females throughout the entire study period (5.0 vs. 2.6 in 1989-2015). Patients across the four age groups experienced continued EM, as compared to the general population during all periods studies. Nevertheless, RS improved with each period for all 4 age groups (Figure 1). More specifically, 5-year RS was 80%, 71%, 64%, and 52% in 1989-1995 for the 4 age groups, as compared with 94%, 90%, 84%, and 75% in 2009-2015 (P<0.001 for all comparisons). The multivariable analysis confirmed an improvement of survival over time, with an EM ratio (EMR) of 2.04 (P<0.001) in 1989-1995, 1.45 (P<0.001) in 1996-2002, and 0.65 (P<0.001) in 2009-2015, as compared with 2003-2008. Furthermore, females had lower EM, as compared to males (EMR, 0.66; P<0.001), whereas patients with a prior malignancy had higher EM, as compared with patients without a prior malignancy (EMR, 1.80; P<0.001) (Table 1). Subgroup analyses confirmed the consistency of the abovementioned associations across the four age groups, with the exception that females and males age ≥80 had comparable EM (EMR, 0.99; P = 0.906). Conclusion: In this large, nationwide, population-based study, 5and 10-year RS improved over time among patients with CLL across all age groups. Advances in supportive care, ameliorated management, and the advent of novel agents might have accounted for the improvement. As kinase inhibitors and anti-apoptotic agents have been introduced recently for routine use, EM will hopefully improve even more in the next decade.