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LEUKEMIA LYMPHOMA MYELOMA
Table of Contents
1 2 E x e cu t i ve S u m m ar y A b o ut t h e D i s e a s e s
2 3 3 Treatment Follow-up Care New Approaches to Treatment Living with Leukemia New Cases Incidence by Gender Incidence by Race and Ethnicity Incidence by Age-Group Signs and Symptoms of Leukemia Possible Causes of Leukemia Treatment of Leukemia Survival Deaths Hodgkin Lymphoma Non-Hodgkin Lymphoma Living with Lymphoma New Cases Incidence by Gender Incidence by Race and Ethnicity Incidence in Children Incidence in Adults Signs and Symptoms Treatment Survival for Adults Survival for Children Deaths Living with Myeloma New Cases Signs and Symptoms Possible Causes Treatment Survival Deaths
Fi gur es
1 2 7 8 8 9
Figure 1: Five-Year Relative Survival Rates, 1960-1963 vs. 1975-1977 vs. 1996-2003 Figure 2: Estimated New Cases (%) of Blood Cancers in 2007 Figure 3: Estimated Proportion of New Cases (%) in 2007 for Each Type of Leukemia Including Adults and Children Figure 4: Age-Specific Incidence Rates for Acute Myelogenous Leukemia (All Races), 2000-2004 Figure 5: Five-Year Relative Survival Rates for All Ages, All Types of Leukemia, 1975-2003 Figure 6: Five-Year Relative Survival Rates for Acute Lymphocytic Leukemia, in Children Under 15 Years of Age, 1964-2003
6 6 6 7 7 7 7 8 8 9 10 10 10 10 10 10 11 11 11 11 11 11 11 13 13 13 13 13 13 13
12 Figure 7: Age-Specific Incidence Rates for Hodgkin Lymphoma, 2000-2004 12 Figure 8: Age-Specific Incidence Rates for Non-Hodgkin Lymphoma, 2000-2004 13 Figure 9: Age-Specific Incidence Rates for Myeloma, 2000-2004
6 6 9
Table 1: The Four Major Types of Leukemia Table 2: Approximate U.S. Prevalence of the Four Major Leukemias as of Jan. 1, 2004 Table 3: Total Estimated Number of New Leukemia Cases in the United States for 2007 Table 4: Estimated Deaths (All Age-Groups) from All Types of Leukemia in 2007
10 Table 5: New Cases of Lymphoma by Gender, 2007 12 Table 6: Trends in Five-Year Relative Survival Rates by Race for Hodgkin Lymphoma and Non-Hodgkin Lymphoma 12 Table 7: Estimated Deaths by Gender from Hodgkin Lymphoma and Non-Hodgkin Lymphoma 14 Table 8: Incidence Rates by Gender, All Races, per 100,000 Population (2000-2004) 14 Table 9: Incidence Rates by Gender, for Blacks, per 100,000 Population (2000-2004) 14 Table 10: Incidence Rates by Gender, for Whites, per 100,000 Population (2000-2004) 15 Table 11: Estimated New Cases of Blood Cancers by Site, by State, 2007 15 Table 12: Estimated Deaths from Blood Cancers by Site, by State, 2007
14 Incidence Rates: Leukemia, Lymphoma a nd My eloma 16 Notes and Definitions 17 Citations 18 About the Society
18 Research 19 Patient Services 20 Advocacy
Cover Photo: Light microscopy (Magnification = 700x) of a human lymphoma cell. Credit: Dr. Cecil H. Fox/Photo Researchers, Inc.
or nearly six people every hour. National Cancer Institute. 2007 and SEER 19731993. lymphoma and myeloma in 2007.1975-1977 vs.313 either have or are in remission from Hodgkin lymphoma.gov. Highlights from the Report Include: New Cases • An estimated 135. This year.310 people in the United States this year. page 16). 19. an annual publication. and myeloma. 21. The next SEER Cancer Statistics Review is expected to be published online in April 2008. lymphoma and myeloma. *Myeloma Biology and Management.520 people in the United States will be diagnosed with leukemia.190 cases of Hodgkin. lymphoma and myeloma will cause the deaths of an estimated 52. Cancer Statistics Review 1975-2004 (see Notes. 138.070 from Hodgkin. 18.424 people living today with myeloma.266 people living today with lymphoma. 405. • In 2007. Survival • An estimated 823. National Cancer Institute.190 cases of non-Hodgkin). • New cases of leukemia. Oxford University Press. Leukemia.650 total cancer-related deaths.240 people will be diagnosed with leukemia. Mortality from the disease increased 24 percent. 2nd Edition. Five-Year Relative Survival Rates 1960-1963 vs. www. This abnormal accumulation interferes with the production of healthy blood cells. • Leukemia causes more deaths than any other cancer among children and young adults under the age of 20. • Non-Hodgkin lymphoma is the fifth most common cancer in the United States. someone is diagnosed with a blood cancer. • This year. lymphoma and myeloma decreased from 1995 to 2004 (the last year data were available).900 people will be diagnosed with myeloma. which becomes malignant and multiplies continuously. 1975-2004. • These blood cancers will account for 9. 71. • Eighty-six percent of myeloma cases occur in people aged 55 and over.4 percent of the 1. This statistic represents 143 people each day. Epidemiology and End Results Program. 1960-1963 1975-1977 1996-2003 Figure 1: Sources: SEER (Surveillance.3 percent of the deaths from cancer in 2007 based on the 559.920 new cancer cases diagnosed in the United States this year. This year. • In general. the likelihood of dying from most leukemias*. The data within Facts 2007-2008 reflect the most recent statistics available from SEER. 44.660 from non-Hodgkin).Executive Summary Facts 2007-2008. in April 2007. the incidence of myeloma increased 8 percent. is a compilation of the most recent data on leukemia. • Every 10 minutes. Deaths • Leukemia.seer. More males are diagnosed with leukemia and more males die of it than females. the National Cancer Institute’s Surveillance.953 either have or are in remission from non-Hodgkin lymphoma (NHL). and its age-adjusted incidence rose by nearly 84 percent from 1975 to 2004. • Thirty-two percent more males are living with leukemia than females.790 people will die from myeloma. LEUKEMIA LYMPHOMA MYELOMA page 1 . lymphoma and myeloma are cancers that originate in the bone marrow or lymphatic tissues as the result of an acquired genetic injury to the DNA of a single cell. 1996-2003 100% 90% 80% 70% Survival Rates 60% 50% 40% 30% 20% 10% 0% Myeloma Hodgkin Lymphoma Non-Hodgkin Lymphoma Leukemia 34% 26% 12%* 14% 48% 40% 31% 74% 64% 50% 35% 86% Leukemia: • There are 218.659 people in the United States who are either living with or are in remission from leukemia. *except acute myelogenous leukemia (AML) and other. From 1975 to 2004.349 Americans are living with leukemia.790 people will die of leukemia. 19. • Every five minutes. 10. Myeloma: • • • • There are 60.730 people will die from lymphoma (1.380 new cases of lymphoma will be diagnosed in the United States (8. Hodgkin and non-Hodgkin lymphoma and myeloma will account for nearly 9. • This year. someone dies from a blood cancer. • In 2007.cancer. 1998. 1996. 63. nonacute myelogenous and monocytic leukemias Lymphoma: • There are 544. Epidemiology and End Results) Cancer Statistics Review.444. These data were published online by SEER. Hodgkin and non-Hodgkin lymphoma.
About the Diseases Leukemia.) of larger adult patients. Autologous transplantation uses the patient’s own marrow stem cells and is technically not transplantation since another person is not the donor. The technique of harvesting stem cells from blood and cord blood has made transplantation available for more LEUKEMIA page 2 LYMPHOMA MYELOMA . and the harvested cells may be treated with chemotherapy agents or monoclonal antibodies to decrease the presence of contaminating tumor cells before they are returned to the patient. Research is being conducted to improve socalled “haploidentical” transplant. Patients with acute lymphocytic leukemia (ALL). freezing and storing of cord blood have provided another source of stem cells for transplantation. The blood or marrow stem cells are collected while the patient is in remission. usually in combinations of two or more drugs. for which a parent rather than a sibling could be the donor. The numbers of stem cells in cord blood are often insufficient for the needs Figure 2: Source: Cancer Facts & Figures. which becomes abnormal (malignant) and multiplies continuously. especially for children. In special instances. studies suggest that two matched cord donors may result in a higher success rate in larger adults. However. 2007. The harvesting. The accumulation of malignant cells interferes with the body’s production of normal blood or immune cells and can result in severe anemia. Stem cells also circulate in large numbers in fetal blood and can be recovered from umbilical cord and placental blood after childbirth. some types of Hodgkin lymphoma. large localized areas of nonHodgkin lymphoma or with special complications that are amenable to radiation therapy may receive both primary chemotherapy and ancillary radiation therapy. especially in young children. (Numbers do not add up to 100% because of rounding. is largely responsible for the dramatic improvement in managing leukemia and lymphoma. If a sibling is not available. There are two major types of stem cell transplants: syngeneic and allogeneic. Such an approach would greatly lessen the proportion of children without a donor. They are considered to be related cancers because they arise from cells with a common origin (the lymphohematopoietic stem cells) and with related functions. Patients with leukemia. The stem cells are frozen and later they can be thawed and infused into the patient if intensive chemotherapy and/or radiotherapy is required for subsequent treatment. Syngeneic transplant describes the use of an identical twin as donor. Blood and Marrow Stem Cell Transplantation: Stem cell transplantation from marrow was introduced approximately 45 years ago and is now standard therapy for selected patients with leukemia. a search of the National Marrow Donor Program registry of tissue-typed volunteers could be made for a matched unrelated donor. decreased ability to fight infections and a predisposition to bleeding. 2007. These diseases usually result from an acquired genetic injury to the DNA of a single cell. An allogeneic transplant uses blood or marrow stem cells from a normal donor. Hodgkin and non-Hodgkin lymphoma and myeloma are cancers that originate in a cell in the bone marrow or lymphatic tissues. lymphoma and myeloma. The technique is important. Approximately 50 different drugs are now being used in the treatment of these diseases. usually a brother or sister with the same tissue type. Estimated New Cases (%) of Blood Cancers in 2007 Myeloma 15% Leukemia 33% Lymphoma 53% Treatment Chemotherapy and Radiotherapy: The use of chemotherapy (anticancer drugs). Cord blood stem cell transplantation provides an additional donor pool and the opportunity for greater ethnic diversity in the blood supply because of collection efforts in hospitals where children of underrepresented ethnic backgrounds are born. slightly mismatched cord stem cell donors may be used quite successfully. myeloma and lymphoma are usually treated with chemotherapy. American Cancer Society.
Several organizations are working on evidence-based guidelines for adult blood cancer patients and their physicians that will standardize follow-up care and increase awareness about long-term and late effects. or genetic factors that can increase susceptibility to certain effects. multi-disciplinary approach to monitoring and supporting cancer survivors. Coordination between specialists and primary care physicians is essential to provide the best care possible. Adolescent. Identifying these biomarkers will allow researchers to develop tests that can predict what effects an individual is at risk of developing. Cancer survivors should have physical examinations yearly or more often. New Approaches to Treatment Several areas of research have resulted in new approaches to the treatment of leukemia. Blood and cord blood transplants differ from marrow transplants principally in the source of the cells collected for transplant. identify recurrence of the disease and detect long-term or late effects. and Young Adult LEUKEMIA LYMPHOMA MYELOMA page 3 . Some treatment centers have follow-up clinics that provide a comprehensive. The effectiveness and tolerance of older patients and the projections from the first five years of clinical trials in newly diagnosed patients suggest that the drug will prolong the duration of hematological remission and life when compared to former therapy. Imatinib mesylate (Gleevec®) is now the drug of choice in newly diagnosed patients with chronic myelogenous leukemia (CML). donors of blood stem cells require special treatment to mobilize sufficient stem cells from marrow into their blood before cells are harvested. as needed. In nonablative transplantation. “Ablation” referred to wipingout the recipient’s cancer. This “graft versus leukemia or lymphoma effect” can suppress (cure) the malignancy and is a prolonged (indefinite) form of immunotherapy. Stem cells not only reside in the marrow but also circulate in the blood. Biomarkers could be high levels of certain substances in the body such as antibodies or hormones. Follow-Up Care Regular medical follow-up enables doctors to assess the full effect of therapy. lymphoma or myeloma and permit the donor’s cells to be accepted by the temporarily immunodeficient recipient. thereby allowing doctors to plan treatment accordingly. Because blood. several important new drugs and new uses for existing drugs have greatly improved cure rates or remission duration for some patients with leukemia. the recipient’s blood cell and immune system are preserved. Over time. as well as marrow. Cancer survivors should see their primary care physicians for general health examinations and an oncologist for follow-up care related to cancer. marrow and immune system. frozen and stored and later transplanted in the patient. two second-generation agents. It has been made possible by more effective immunosuppressive drugs that are capable of preventing rejection of the donor’s cells without full intensity treatment of the patient’s immune system. Gleevec offers several dramatic advantages to patients: oral administration. the donor’s cells take hold and the patient’s leukemia. ablation of the recipient’s blood-cell forming and immune cells was the price that had to be paid to eradicate the leukemia. Although a minority of patients have developed resistance to the drug. Cancers (http://www. This still experimental approach greatly lessens the early toxicity of transplantation and has extended the age at which recipients with leukemia. lymphoma and myeloma. few severe adverse effects on normal tissues and a very high response rate. these cells can be harvested from the blood of a donor. It works by blocking the oncogeneencoded protein product that instigates the transformation to a leukemic cell. Most follow-up clinics specialize in pediatric cancer survivors. but some follow adult cancer survivors. Regular examinations may include screening for cancer recurrence or the development of secondary cancer or other late effects of treatment. Development of New Drugs: In the past decade. To ensure there will be enough blood stem cells for successful transplantation. “Nonablative” allogeneic stem cell transplantation is the term applied to a technique of allogeneic transplant that uses lower doses of chemotherapy and/or radiotherapy to prepare the recipient for the donor’s stem cells.childrensoncologygroup.org/). lymphoma or myeloma is attacked and suppressed by donor lymphocytes that form from the donor stem cells. making the procedure more tolerable. lymphoma or myeloma can have an allogeneic transplant. is a source of stem cells for transplantation. In standard stem cell transplantation. decreased side effects. Predictive tests: Research is under way to identify biomarkers that may indicate a higher-than-normal risk of developing a specific long-term or late effect. The protein is an enzyme in the family of tyrosine kinases. Follow-Up Guidelines: The Children’s Oncology Group has established Long-Term Follow-Up Guidelines for Survivors of Childhood.patients.
thalidomide (Thalomid®). a less common type of chronic lymphocytic leukemia (CLL). This drug is also being tested in clinical trials to treat adult acute leukemia and MDS. Clofarabine (Clolar®). principally. was approved by the FDA for newly diagnosed myeloma. PDGFR or KIT oncoproteins). Some patients with moderately severe. Bendamustine (TreandaTM) is showing promising results in clinical trials to treat indolent non-Hodgkin lymphoma that does not respond to rituximab (Rituxan®) neither as a single agent nor in combination with chemotherapy. in combination with dexamethasone. vincristine (Oncovin®) and prednisone–therapy for diffuse large B-cell lymphoma. Cell surface antigens have been given a cluster designation (CD) followed by a number.dasatinib (Sprycel®)(approved by the U. a thalidomide derivative. lymphoma or myeloma. The treatment of hairy cell leukemia. Patients with more severe forms of MDS are very unlikely to respond to the agent. Arsenic trioxide also adds to the drugs available to treat this subtype of acute leukemia. but without this specific chromosome 5 abnormality. although initially used in indolent lymphomas. Early studies indicate the combination of arsenic trioxide and all-trans retinoic acid may be a further advance in the initiation of therapy. LEUKEMIA page 4 LYMPHOMA MYELOMA . Velcade is approved by the FDA for treating people with myeloma who have had at least one prior therapy. immune cell administration and vaccine development. such as follicular lymphoma. farnesyl transferase inhibitors and reduced-intensity stem cell transplantation. but it can also induce remissions in some cases of acute leukemia. reducing the need for transfusions in some patients. kill unhealthy bone marrow cells and may help the bone marrow function more normally in MDS patients. however. is being used to treat relapsed or refractory acute lymphocytic leukemia (ALL) in children who have received at least two prior therapies. Food and Drug Administration [FDA] in 2006) and nilotinib (in clinical trials). Cladribine induces long-term remissions in nearly 90 percent of patients treated at diagnosis for one week. Lenalidomide (Revlimid®). Pentostatin is another effective drug that can be used in patients with hairy cell leukemia who do not respond to cladribine. suppresses the progression of leukemia. Trials are under way to determine if one of these second-generation drugs should become the drug of choice to initiate therapy and if the use of two drugs would be better than one. approved by the FDA for all types of MDS. chronic eosinophilic leukemia (formerly hypereosinophilic syndrome). Two additional drugs being studied in clinical trials have shown responses in a subset of patients with myeloma: the proteasome inhibitor bortezomib (Velcade®) and the immune modulator (Revlimid®). symptomatic anemia have improvement in hemoglobin levels with this agent. cyclophosphamide. are entering clinical use and can overcome this resistance in some cases. approved by the FDA in 2005.S. The remission rate and duration of remission of acute promyelocytic leukemia (APL) has been improved significantly with the introduction of all-trans retinoic acid in combination with chemotherapy (anthracycline antibiotic). It is especially active against the lymphocytes in CLL. doxorubicin (Adriamycin®). In May 2006. Rituximab has become an important agent to treat CD20-positive lymphocytic malignancies. Three types of immunotherapy are being explored: antibody treatment. thus rituximab is an anti-CD20 antibody. Rituximab is an antibody directed at the target CD20 antigen on B-cell lymphoma cells. Monoclonal Antibody Therapy: Monoclonal antibodies are laboratory-produced proteins that can be infused into an appropriate patient. Other therapies in clinical research to treat MDS include arsenic trixoxide. perhaps 20 percent of cases also derive benefit. Immunotherapy: This is a treatment that uses immune cells or antibodies to fight the disease. the most prevalent lymphoma subtype. Azacitidine (Vidaza®). it has now become an important fifth drug in the R-CHOP–rituximab. Indeed. Revlimid is approved by the FDA in combination with dexamethasone for the treatment of myeloma patients who have received at least one prior therapy. and enhances the specificity of treatment to minimize toxic effects on normal tissues. occasional cases of chronic myelomonocytic leukemia (CMML) and in systemic mastocytosis because patients with these conditions have a genetic abnormality that results in an abnormal tyrosine kinase that is blocked by imatinib (mutant ABL. has been approved by the FDA for the treatment of a specific type of myelodysplastic syndrome (MDS) that results from an alteration in chromosome 5. Monoclonal antibodies have added to the arsenal of agents that are used for the treatment of patients with lymphoma and leukemia. has improved dramatically with the introduction of cladribine. Alemtuzumab (Campath®) is a monoclonal antibody directed against the antigen CD52 found on T and B lymphocytes. and Decitabine (Dacogen®). In patients with anemia. Gleevec is not only a very important new agent in the treatment of CML.
In patients with CML who have relapsed after stem cell transplantation. Patients with myeloma have also had remission re-induced by donor lymphocytes. In studies of CML. The goal is to extend the duration of remission achieved by remissioninduction therapy of various types. new forms of cancer therapy may be developed. These agents are currently being tested in patients with AML and myeloma in the hope that they may decrease drug resistance and increase the rate of a prolonged response to therapy. drugs are designed to interfere with the oncoprotein and prevent its effect on the cell. Some vaccines contain antigens or parts of antigens purified from cancer cells obtained from the patient or from the same type of cancer cells but obtained from another patient. gemtuzumab (Mylotarg®). Many cancer treatment vaccines under development are intended to induce antigen-specific antitumor immune responses. They deliver the toxic substance directly to the cancer cells. Monoclonal antibodies can also be linked to a radioactive isotope to target and kill specific cancer cells. Vaccines: Experimental treatment vaccines are now being studied to treat certain types of lymphoma. lymphoma or myeloma cells. is approved for older patients with AML who relapse after initial treatment. less responsive to therapy. the patient’s immune cells would be treated in the laboratory to train them to attack the residual leukemia. LEUKEMIA LYMPHOMA MYELOMA page 5 . lymphoma and myeloma. These types of vaccines would be used in patients who have small amounts of residual blood cancer after chemotherapy or stem cell transplantation. If the gene in the former case is an oncogene or the protein in the latter case is an oncoprotein. Gene Therapy: One approach to this type of treatment is to use “antisense” agents that block the encoding instructions of an oncogene so that it cannot direct the formation of the corresponding oncoprotein that causes the cell to transform into a malignant cell. These agents can act on the gene (DNA) or on RNA to prevent the formation of the gene product or protein (oncoprotein) that is the direct cause of transforming the cell into a malignant type. This means that the vaccine induces an immune response against the cancer cells present in the patient. In some approaches. These cells are. some vaccines are made from leukemic cells treated in test tubes to convert them to potent antigen-presenting cells. In one approach. Two new and potentially important approaches include a) the application of RNA interference. or become. These antibodies are injected into the patient in the hope that the antibodies will latch on to the antigen on the cancer cells and destroy the cells. The goal of several new agents being studied is to decrease resistance to an important chemotherapy drug used in leukemia. myeloma and leukemia. Reversal of Multidrug Resistance: The malignant cells of patients have mechanisms that may allow them to escape the damaging effects of chemotherapy agents. These drugs have been approved to treat relapsed B-cell non-Hodgkin lymphoma. DNA vaccines that contain the DNA that encodes the specific antigen are being tested. Vaccines are in clinical trials for types of acute and chronic leukemia.Another antibody that has been approved for use by the FDA to treat certain patients with acute myelogenous leukemia (AML) is linked to a chemical toxin called calicheamicin. gene therapy researchers are trying to modify an oncogene (BCR-ABL) that produces a protein that stimulates malignant cell growth. This type of treatment is being studied intensively to learn more about the basis for this immune cell effect and to expand it for use in other situations. and aptamer treatment. Paradoxically. This drug. In each case. Studies of vaccines used in patients with follicular or indolent lymphoma have demonstrated an immune response. An alternative strategy called molecular targeted drug development targets the oncoprotein. Approaches to reversing multidrug resistance are under study. b) a modality that uses molecules of RNA to silence complementary (DNA) genes. Examples of this treatment are the drugs ibritumomab (Zevalin®) and tositumomab and iodine I131 tositumomab (Bexxar®). These are called conjugated monoclonal antibodies. a technique that prepares small molecules in the laboratory that have the ability to inactivate proteins that cause disease. the basis for the vaccine is to make the cancer cells susceptible to immune attack by heightening the recognition of markers on the cancer cells. cells are isolated in the laboratory and start making antibodies after insertion of the cancer antigen. In another approach. the infusion of the original marrow donor’s lymphocytes can re-induce remission.
*Prevalence estimates are expressed here as the number of people living in whom the first involved tumor for each cancer site was diagnosed during the previous 29 years. Leukemia is expected to strike more than 10 times as many adults as children in 2007.790). Statistical Research and Applications Branch.501 50.570 19. and End Results) Cancer Statistics Review 1975-2004. American Cancer Society. Acute leukemia is a rapidly progressing disease that results in the accumulation of immature.570 5. New Cases An estimated 44. The lack of normal white cells impairs the body’s ability to fight infections.240 Male 3. develops in virtually all leukemia patients. released April 2007.000 2.S.380 6. Only 2. functionless cells in the marrow and blood. Estimated 29-Year L-D Prevalence Counts on 1/1/2004 by Duration. and SEER Program.410 4. 1. National Cancer Institute.659 people in the United States are living with leukemia.S. 2007. LEUKEMIA page 6 LYMPHOMA MYELOMA . DCCPS. • Most cases of leukemia occur in older adults.800 children.Leukemia Leukemia is a malignant disease (cancer) of the bone marrow and blood.960 7. *Note: Incidence rates are the number of new cases in a given year not counting the preexisting cases. The four major types of leukemia are shown in Table 1. Table 3: Source: Cancer Facts & Figures 2007. Prevalence database: U. The Four Major Types of Leukemia Acute lymphocytic leukemia Acute myelogenous leukemia Table 1 Chronic lymphocytic leukemia Chronic myelogenous leukemia Living with Leukemia An estimated 218.140 6.570 3. (About 40. Leukemia is divided into four categories: myelogenous or lymphocytic. functional cells to be made. The incidence rates are usually presented as a specific number per 100.150 24.4 percent of leukemias in children aged 0-19 are CML. In 2007. It is characterized by the uncontrolled accumulation of blood cells.440 Table 2: Sources: SEER (Surveillance. NCI. Approximate U.340 13. 2004 Type Chronic lymphocytic leukemia Chronic myelogenous leukemia Acute lymphocytic leukemia Acute myelogenous leukemia Prevalence* 95. aged 0-19. Incidence by Gender Incidence rates* for all types of leukemia are higher among males than among females.200 15. • About 33 percent of cancers in children aged 0-14 years are leukemia • Most cases of chronic myelogenous leukemia (CML) occur in adults. Surveillance Research Program. Anemia. a deficiency of red cells.060 2.060 8. based on the November 2006 SEER data submission.189 27.289 Total Estimated Number of New Leukemia Cases in the United States for 2007 Type Acute lymphocytic leukemia Chronic lymphocytic leukemia Acute myelogenous leukemia Chronic myelogenous leukemia Other forms of leukemia Total Individuals 5. The marrow often no longer produces enough normal platelets. Chronic leukemia progresses more slowly and allows greater numbers of more mature.440 adults compared with 3.240 new cases of leukemia will be diagnosed in the United States this year.579 21. A shortage of platelets results in bruising and easy bleeding.350 2. Epidemiology. red blood cells and white blood cells. each of which can be acute or chronic. The terms myelogenous or lymphocytic denote the cell type involved.720 44. more than half of all cases occur after age 67. males are expected to account for 56 percent of the new cases of leukemia.800 Female 2. 2007. • The most common form of leukemia in children is acute lymphocytic leukemia (ALL).000 population.) • The most common types of leukemia in adults are acute myelogenous leukemia (AML) and chronic lymphocytic leukemia (CLL). Nearly 54 percent of the new cases of this disease will occur among children in 2007 (about 2. Prevalence of the Four Major Leukemias as of Jan. Chronic leukemias account for 7 percent more of the cases than acute leukemias.
From 1975 to 2000. was 504 per 100. Possible Causes of Leukemia Anyone can get leukemia. white and Asian/Pacific islander children than for black children. American Cancer Society. neither explains most cases. leukemia rates are higher in Americans of European descent than among those of African descent. The most common form of leukemia among children under 20 years of age is ALL.900 new cases of cancer diagnosed in African-Americans in 2007. In the 17 SEER regions of the United States. It is estimated that in 2007. Leukemia is one of the top 15 most frequently occurring cancers in minority groups. The cause of leukemia is not known. CLL incidence increases dramatically among people who are aged 50 and older. Hispanic children of all races under the age of 20 have the highest rates of leukemia. They do warrant medical evaluation. Adolescents and Young Adults. the incidence of AML slowly rose while that of ALL steadily decreased in the period from late adolescence to older adulthood. The leukemias represented 27 percent of all cancers occurring among children younger than 20 years from 2000-2004. Leukemia incidence is highest among whites and lowest among American Indians/Alaskan natives. About 2. The incidence rate for all cancers among AfricanAmericans in the Seer (17 region). Leukemia strikes all ages and both sexes. 2007. Although chronic exposure to benzene in the workplace and exposure to extraordinary doses of irradiation can be causes of the disease. from 2000-2004. there were 4. These cancers are most prevalent in the seventh. However. Incidence by Race and Ethnicity Incidence rates for all types of cancer combined are more than 5 percent higher among Americans of African descent than among those of European descent. Leukemia rates are substantially higher for Hispanic. Figure 3: Source: Cancer Facts & Figures 2007.to 4-year-old children is more than nine times greater than the rate for young adults ages 20 to 24.Estimated Proportion of New Cases (%) in 2007 for Each Type of Leukemia Including Adults and Children 3. Some people with chronic leukemia may not have major symptoms and are diagnosed during a medical examination. including the examination of the cells in blood or marrow. Most children under 15 years of age with ALL are cured. CML incidence also increases dramatically among people who are aged 60 and older. and AML incidence increases dramatically in people who are aged 60 and older. eighth and ninth decades of life. LEUKEMIA LYMPHOMA MYELOMA page 7 . Adults.790 new cases of childhood ALL are expected to occur in 2007.000 population. including 3. The diagnosis of leukemia requires specific blood tests.to 29-year olds.5 times that of ALL.800 children will be diagnosed with leukemia throughout the United States. averaging about 189. Children. Among 15. American Indian/Alaskan natives. The American Cancer Society estimates that there will be approximately 152. AML incidence was approximately 1.922 cases per year. In 25. These signs are not specific to leukemia and may be caused by other disorders.799 children under the age of 20 diagnosed with leukemia from 2001-2004.to 19-year olds. The incidence of ALL among 1. Incidence by Age-Group Incidence rates by age differ for each of the leukemias. Signs and Symptoms of Leukemia Signs of acute leukemia may include • Easy bruising or bleeding (because of platelet deficiency) • Paleness or easy fatigue (because of anemia) • Recurrent minor infections or poor healing of minor cuts (because of inadequate white cell count). ALL incidence was approximately twice that of AML.619 with ALL. Other 13% ALL 12% CM L 10% CLL 35% A ML 30% There is optimism within centers that specialize in the treatment of children because survival statistics have dramatically improved over the past 30 years.
a patient had a 14 percent chance of living five years.4 5-9 0.9 15-19 0. the overall relative survival rate was nearly 50 percent. The relative survival rates differ by age of the patient at diagnosis.2 10.4 percent for children under 5 • CLL: 74.8 1-4 0. gender. National Cancer Institute. During 1996-2003.3 1. By 1975-1977. 2000-2004 25 23.1 4.6 2. race and type of leukemia.000) 17 15.9 25-29 1. Relapse indicates return of the cancer cells and the return of other signs and symptoms of the disease. Epidemiology and End Results) Cancer Statistics Review 1975-2004.3 percent overall.8 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age in Years Figure 4: Sources: SEER (Surveillance.2 23 21 19 19.7 percent overall.2 15 13 11 9 7.8 percent • AML: 20. 54. Treatment of Leukemia The aim of treatment is to bring about a complete remission. In 1960-1963. a complete remission (no evidence of disease in the blood or marrow) that lasts five years after treatment often indicates cure.4 <1 0. 1975-2003 50% 42% 38% 39% 44% 47% 48% 50% Survival Relative survival compares the survival rate of a person diagnosed with a disease with that of a person without the disease.4 percent Five-Year Relative Survival Rates for All Ages. The five-year relative survival rate has more than tripled in the past 47 years for patients with leukemia. and in 1996-2003.2 1. Epidemiology and End Results) Cancer Statistics Review 1975-2004.7 7 5 3 1 0 1. the five-year relative survival rate had jumped to 35 percent. LEUKEMIA page 8 LYMPHOMA MYELOMA .3 3.1 Incidence (per 100. National Cancer Institute. Thirty-two percent more males than females are living with leukemia.6 10-14 0. 2007. 90. the five-year relative survival rates overall were: • ALL: 65. when compared to a person without leukemia.5 21. 2007. Survival Rates 40% 30% 20% 10% 0% 35% 1975-77 1978-80 1981-83 1984-86 1987-89 1990-92 1993-95 1996-2003 Years Figure 5: Sources: SEER (Surveillance. Treatment centers report increasing numbers of patients with leukemia who are in complete remission at least five years after diagnosis of their disease. For acute leukemia. All Types Leukemia.1 for children under 15 • CML: 44. Complete remission means that there is no evidence of the disease and the patient returns to good health with normal blood and marrow cells.9 20-24 0.Age-Specific Incidence Rates for Acute Myelogenous Leukemia (All Races).
National Cancer Institute. Survival Rates 50% 40% 30% 20% 10% 0% 19641 197519772 197819802 198119832 198419862 198719892 199019922 199319952 199620032 3% Years Figure 6: The graph shows childhood ALL five-year relative survival rates have improved significantly over the past nearly 40 years. Despite this decline. There will be an estimated 8. Hispanics with leukemia who are under the age of 25 had the highest mortality rates from the disease between 1990 and 1999. 2007. Zuelzer WW. Unclassified forms of leukemia will account for 6.320 males and 9.680 12.710 9. Epidemiology and End Results).970 250 2.500 8.940 3. African-Americans who were diagnosed with leukemia between the ages of 25 and 44 had the highest death rates from the disease during this period.390 additional deaths. Deaths It is anticipated that approximately 21. Estimated Deaths (All Age Groups) from All Types of Leukemia in 2007 Type Acute lymphocytic leukemia Chronic lymphocytic leukemia Acute myelogenous leukemia Chronic myelogenous leukemia Other.470 Table 4: Source: Cancer Facts & Figures 2007. leukemia causes more deaths than any other cancer among children and young adults under age 20. Non-Hispanic whites diagnosed with leukemia over the age of 44 had the highest death rates during this period.020 240 3.420 4. SEER (Surveillance.790 deaths in the United States will be attributed to leukemia in 2007: 12. leukemia will be the fifth most common cause of cancer deaths in men and the sixth most common in women. The leukemia death rate for children from 0 to 14 years in the United States has declined about 70 percent over the past three decades. deaths from leukemia are expected to be distributed in the following numbers: In 2007. In 2007. 2007. Blood. Cancer Statistics Review. 1964-2003 90% 80% 70% 60% 58% 71% 66% 73% 78% 83% 84% 87% The estimated numbers of deaths attributed to leukemia in the United States are 30 percent higher for males than for females.990 deaths from AML and 490 deaths from CML. Implications of long-term survivals in acute stem cell leukemia of childhood treated with composite cyclic therapy.470 females. unclassified forms of leukemia Total Overall 1.420 deaths from ALL. in Children Under 15 Years of Age. There will be an estimated 4.990 490 6. 1975-2004.Five-Year Relative Survival Rates for Acute Lymphocytic Leukemia. In 2007. 1964:24:477-494. 2. American Cancer Society.790 Male 820 2. Sources: 1. LEUKEMIA LYMPHOMA MYELOMA page 9 .560 5. about 515 children under the age of 14 are expected to die from leukemia.500 deaths from CLL and 1.320 Female 600 1.390 21.
Lymphoma Lymphoma is a general term for a group of cancers that originates in the lymphatic system.710 Total 8. American Cancer Society.5 percent of all lymphomas diagnosed in 2007. Persons infected with the human immunodeficiency virus (HIV) have a much higher risk of developing lymphoma. Both Hodgkin and non-Hodgkin lymphomas are more common in males than in females.190 63.9 per 100.S. rose by 84 percent from 1975 to 2004. The groups are often classified as indolent or aggressive. Hodgkin Lymphoma Hodgkin lymphoma is a specialized form of lymphoma and will represent about 11. It is the sixth most common cause of cancer deaths in males and in females. Hodgkin lymphoma has characteristics that distinguish it from all other cancers of the lymphatic system. Incidence rates for Hodgkin lymphoma tend to be higher among males than among females. Living with Lymphoma In the United States in 2007. The bacterium Helicobacter pylori is associated with the development of lymphoma in the stomach wall. eventually crowding out healthy cells and creating tumors that enlarge the lymph nodes or other sites in the body. Fifty-three percent of the blood cancers diagnosed are lymphomas. New Cases of Lymphoma by Gender.470 34.000 for females.000 for males and 38.190 cases of non-Hodgkin lymphoma). including the presence of an abnormal cell called the ReedSternberg cell (a large. More than four percent of all cases of Hodgkin lymphoma diagnosed in 2007 will be in children under 15 years of age. Age-specific incidence rates of non-Hodgkin lymphoma are 2.380 Table 5: Source: Cancer Facts & Figures 2007. The reasons for the development of non-Hodgkin lymphoma are not certain.990 32.190 71. In 2004.000 for females.9 per 100. Non-Hodgkin Lymphoma Non-Hodgkin lymphoma represents a diverse group of cancers with the distinctions between types based on the characteristics of the cancerous cells. they are 52.Hodgkin lymphoma are higher in Americans of European descent than among those of African descent. malignant cell found in Hodgkin lymphoma tissues). Non-Hodgkin lymphoma is the fifth most common cancer in males and females in the United States. while 0. By ages 60 to 64. These risk factors explain only a small proportion of cases. After 50 to 54 years of age.8 percent.953 people living with nonHodgkin lymphoma for a total of 544. The age-adjusted incidence of non-Hodgkin lymphoma Incidence by Race and Ethnicity Although blacks in their mid 20s to late 40s have higher incidence rates of non-Hodgkin lymphoma than whites. incidence rates for non.670 Female 3.266 members of the U. or low.3 per 100. 2007 Type Hodgkin lymphoma Non-Hodgkin lymphoma Total Male 4. Each histologic grouping is diagnosed and treated differently. LEUKEMIA page 10 LYMPHOMA MYELOMA .720 28. and each has prognostic factors that categorize it as more or less favorable. in general whites have higher incidence rates than blacks.313 people living with Hodgkin lymphoma (active disease or in remission) and 405. the difference was small. an average annual percentage increase of 2.380 Americans will be diagnosed with lymphoma in 2007 (8.200 38. The Epstein-Barr virus causes Burkitt’s lymphoma in Africa. Lymphoma results when a lymphocyte (a type of white blood cell) undergoes a malignant change and begins to multiply.190 cases of Hodgkin lymphoma and 63. The incidence of Hodgkin lymphoma is consistently lower than that of non-Hodgkin lymphoma. 2007. there are 138.6 per 100. population who are living with lymphoma.000 at ages 20 to 24 for males and 1. intermediate and high grade. New Cases About 71. Incidence by Gender Table 5 illustrates the breakdown of incidence of lymphoma by gender.7 percent of all cases of non-Hodgkin lymphoma will be diagnosed in children under 15 years of age this year. Immune suppression plays a role in some patients.
Non-Hodgkin lymphoma is the ninth most common cause of cancer death in males and the seventh in females in the United States.2 percent for Hodgkin lymphoma in people under 20 years of age. recurrent high fever. In the United States. depending on the tumor size.1 per 100.4 cases per 100. and non-Hodgkin lymphoma. This represents a significant improvement in the rate of recovery. The rate increases more than 18 times to 45.0/1 million population). following leukemia (26.660 from non-Hodgkin lymphoma. LEUKEMIA LYMPHOMA MYELOMA page 11 . followed closely by Hispanic children of all races (24.5 percent) are the third most common cancers in children. 4. chemotherapy or both may result in cures for most patients with Hodgkin lymphoma.to 24year-old individuals. sweating at night. The five-year relative survival rate for patients with Hodgkin lymphoma has more than doubled from 40 percent in whites in 1960-1963 to more than 86 percent for all races in 1996-2003. 1. the highest incidence of non-Hodgkin lymphoma is in Asian/Pacific islanders. It is rarest among American Indian/ Alaskan native children. cell type and location of the lymphoma.5 percent. Treatment Hodgkin lymphoma is often treated with radiation and chemotherapy. 3. Survival for Children Five-year relative survival is 95.1 cases per 100. Adolescents are more commonly diagnosed with Hodgkin lymphoma than young children. armpit or groin. Lymphomas (Hodgkin lymphoma. Five-year relative survival is now 95 percent for Hodgkin lymphoma in children aged 0 to 14 years. most children with nonHodgkin lymphoma did not live five years after diagnosis. Signs and Symptoms Signs and symptoms of Hodgkin lymphoma include painless swelling of lymph nodes in the neck. about 10. and is the eighth most common cause of cancer death in that group. widespread disease requires chemotherapy or chemotherapy and/or monoclonal antibody therapy with radiation. excessive tiredness. five-year relative survival for non-Hodgkin lymphoma is now 83. In children under 20 years of age. Early stage. and more than 46-fold to 112. Radiation. groin or in the abdomen. loss of appetite and bone pain. The most common early sign of other forms of lymphoma is also painless swelling of the lymph nodes – usually in the neck. night sweats. In children up to age 14 years. The incidence in this group decreased almost steadily and significantly between 1975 and 1999.070 from Hodgkin lymphoma). persistent fatigue. Incidence in Adults The incidence of non-Hodgkin lymphoma increases with age. troublesome itching and weight loss. Hodgkin lymphoma incidence rates are higher in adolescents and young adults than in adults in their middle years. The five-year relative survival rate for non-Hodgkin lymphoma patients has risen from 31 percent in whites in 1960-1963 to 63.000 children in 2004. indigestion and abdominal pain. In children from 0 to 19 years of age. Incidence in Children The incidence of Hodgkin lymphoma among people under 20 years of age was 1.730 persons will die from lymphoma in the United States in 2007 (18. Survival for Adults Hodgkin lymphoma is now considered to be one of the most curable forms of cancer. armpit. Deaths An estimated 19. comprising nearly 5 percent of all cancers diagnosed. localized non-Hodgkin lymphoma is sometimes treated with radiation.Among women. It has remained fairly constant since 1999. Even in the mid-1970s.8 percent) and neoplasms of the brain and other nervous tissue (17.9 percent).5 percent. Symptoms also often include fever. About 2.5/1 million population).1 cases per 100. the highest incidence of non-Hodgkin lymphoma is in non-Hispanic whites.8 percent for all races in 1996-2003. From ages 15 to 19. lymphomas are most commonly diagnosed in whites (24.000 people occur in 20. Death rates have been declining for Hodgkin lymphoma patients since the mid-1970s. Treatment for non-Hodgkin lymphoma sometimes includes vaccines and other forms of immunotherapy.000 persons at ages 80 to 84. Non-Hodgkin lymphoma is the fifth most common cancer in Hispanics. Hispanics of all races have the second highest incidence rates of non-Hodgkin lymphoma after whites.000 by ages 60 to 64.400 children under the age of 15 will be diagnosed with cancer in 2007.
5 10.4 15.0 20 10 0 0.000) 5 4 3 2 1 0 0.0 100.4 3. National Cancer Institute.9 7.9 3.1 102.4 4. National Cancer Institute.4 2.1 3. Table 6: Source: SEER (Surveillance. 2007.6 32. Epidemiology and End Results) Cancer Statistics Review 1975-2004.730 Male 770 9.4 2.4 2.600 10.Age-Specific Incidence Rates for Hodgkin Lymphoma. National Cancer Institute.360 Non-Hodgkin Lymphoma All races Whites African-Americans 1975-77 48% 48% 49% 1981-83 1990-92 1996-2003 53% 53% 50% 52% 53% 42% 64% 65% 56% Table 7: Source: Cancer Facts & Figures 2007.060 9.4 2.8 112. American Cancer Society. Age-Specific Incidence Rates for Non-Hodgkin Lymphoma.9 1.8 2. Epidemiology and End Results) Cancer Statistics Review 1975-2004.8 3.0 0. 2000-2004 110 100 90 80 Incidence (per 100.3 <1* 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age in Years Figure 7: Sources: SEER (Surveillance.3 4.0 3.1 0. 2007. 2007. LEUKEMIA page 12 LYMPHOMA MYELOMA .5 <1* 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age in Years 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Figure 8: Sources: SEER (Surveillance.2 1.4 80. 2000-2004 6 Incidence (per 100.9 4. Trends in Five-Year Relative Survival Rates by Race for Hodgkin Lymphoma and Non-Hodgkin Lymphoma Hodgkin Lymphoma All races Whites African-Americans 1975-77 1981-83 74% 74% 71% 76% 76% 73% 1990-92 1996-2003 83% 84% 74% 86% 87% 81% Estimated Deaths by Gender from Hodgkin Lymphoma and Non-Hodgkin Lymphoma Type Hodgkin lymphoma Non-Hodgkin lymphoma Total Overall 1. 2007.1 4.8 4.070 18.0 1.370 Female 300 9. *<16 cases per time interval.000) 70 60 50 40 30 22.1 3.0 45.1 0.1 63.2 4. * <16 cases for time interval.660 19.0 2.6 0. Epidemiology and End Results) Cancer Statistics Review 1975-2004.
3/100. LEUKEMIA LYMPHOMA MYELOMA page 13 .960 men and 8. tire more easily and feel weak. Fractures may occur as a result of the weakened bones.000) for all racial and ethnic groups.940 women) new cases of myeloma will be diagnosed in the United States in 2007. myeloma was the 10th most commonly diagnosed cancer among African-American men and women. causing pain and crowding out normal blood cell production. Lenalidomide is approved by the FDA in combination with dexamethasone for the treatment of myeloma patients who have received at least one prior therapy.5 3.000). 2007.9 9. destroying normal bone tissue. *<16 cases for each age interval. • Americans of African descent have a much higher incidence rate. Living with Myeloma An estimated 60. (11.1 5. SEER 17 areas (<1.5/100.5/100. Age-Specific Incidence Rates for Myeloma. the cell that forms plasma cells. 15-19. Survival Current statistical databases show that overall five-year relative survival in patients with myeloma has shown a significant improvement since the 1960s: 12 percent in 1960-1963 for whites to 34 percent from 1996-2003 for all races. 5-9.7 1. From 2000 to 2004.2/100.1 Signs and Symptoms Often the first symptom of myeloma is bone pain caused by the effects of myeloma cells in the marrow. 20-24). The onset of myeloma interferes with normal production of antibodies and makes myeloma patients susceptible to infections. a B lymphocyte. approximately double. Approximately 3 percent of all cancer-related deaths among AfricanAmericans in 2000-2004 were from myeloma. The highest rates are found in black men 80 to 84 years of age and older (105/100. becomes malignant.1 0. Thalidomide is approved by the FDA for use in treating newly diagnosed myeloma.000 to 3. New Cases An estimated 19. Malignant plasma cells produce an abnormal protein called monoclonal immunoglobulin. Treatment Chemotherapy for myeloma has led to sustained remissions in some patients.000). The U. and it rarely occurs in people under age 45.Myeloma Myeloma is a cancer of the plasma cells. 1-4. Bortezomib has been approved for treating myeloma in patients who have had at least two prior therapies. Immunoglobulins (or antibodies) are an important part of the body’s natural defense against infection because they recognize microbes that invade the body and permit them to be removed and destroyed. but it is the most difficult blood cancer to treat successfully. Epidemiology and End Results) Cancer Statistics Review 1975-2004. a type of white blood cell found in many tissues of the body. Myeloma was the 10th most common cause of cancer deaths for women in 2000-2004. Deaths Approximately 10. Usually. 10-14. Figure 9: Source: SEER (Surveillance.000) is 56 percent higher than for women (4.000) 40 30 20 10 0 0-24 0.S.424 people in the United States are living with myeloma. Total survival for white males.900 (10. In myeloma.790 deaths from myeloma are anticipated this year. • The incidence rate in men (7/100.000).1/100. At times. but primarily in the bone marrow.0 37.000) of myeloma than those of European descent (5. especially in the marrow.3 0. The mortality rate from myeloma for people of African descent is more than double the rate for whites (7. Sixty percent of those were diagnosed with the disease within the past four years. Treatment is aimed at slowing progress of the disease. • The median age at diagnosis for African-Americans is 67.4 33. • The median age at diagnosis is 70. It is 71 for African-Americans. median age at death from multiple myeloma is 74. 2000-2004 Incidence (per 100. It grows continuously and forms masses of plasma cells. two or three drugs are used simultaneously. National Cancer Institute. Patients may have anemia.8 14. has been increasing.1 21. Recurrent infections may be an early sign of the disease. the patient’s own stem cells are used (autologous stem cell infusion). 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age in Years Possible Causes The cause of myeloma is not known. especially.1 28.4 35. Treatment may include intensive chemotherapy followed by stem cell transplantation to restore normal blood cell production.
2 14.1 Table 10: Source: SEER (Surveillance. Epidemiology and End Results) Cancer Statistics Review 1975-2004.3 2. National Cancer Institute.0 Female 8.6 Female 9.2 18. 2007.9 2.0 7. (Based on SEER 17 areas. Rates are per 100. Incidence Rates by Gender.0 Female 9.0 23. (Based on SEER 17 areas.5 16.1 3.6 4.6 2. Epidemiology and End Results) Cancer Statistics Review 1975-2004. 2007. per 100.1 2. National Cancer Institute.8 14. for Blacks. per 100.5 Table 8: Source: SEER (Surveillance.7 24.2 3.000 Population (2000-2004) Type Leukemia Non-Hodgkin lymphoma Hodgkin lymphoma Myeloma Overall 12. (Based on SEER 17 areas.3 Male 13. for Whites.2 2. Epidemiology and End Results) Cancer Statistics Review 1975-2004. the most recent available.4 11.0 2.000 Population (2000-2004) Type Leukemia Non-Hodgkin lymphoma Hodgkin lymphoma Myeloma Overall 12. Hodgkin and non-Hodgkin lymphoma and myeloma use figures from 2000-2004.) Table 9: Source: SEER (Surveillance.9 5.6 Male 16.Incidence Rates: Leukemia.3 19.3 2. National Cancer Institute. per 100. Lymphoma and Myeloma The following tables showing incidence rates for leukemia. 2007.) LEUKEMIA page 14 LYMPHOMA MYELOMA .2 6.5 Incidence Rates by Gender.1 11.7 5.8 20.1 9.9 17.) Incidence Rates by Gender.2 Male 16.000 population and are age-adjusted to the 2000 population.4 4. All Races.000 Population (2000-2004) Type Leukemia Non-Hodgkin lymphoma Hodgkin lymphoma Myeloma Overall 10.
680 920 340 890 170 290 330 190 1. January/February 2007. model (see below). *Estimate is fewer than 50 cases.630 540 80 120 990 510 310 230 320 330 100 390 490 770 400 210 460 80 150 160 100 680 120 1.190 290 * 280 200 1.250 1.080 1.070 80 330 70 480 1.260 220 400 420 290 2.160 140 50 360 440 170 320 * 18. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Total** 550 70 740 510 4.530 1. Used with permission. Numbers are rounded to the nearest 10. and additional data supplied by the American Cancer Society based on data from the U.390 1.880 240 250 50 50 1.410 130 50 500 490 130 490 * 21.520 310 3. by State.030 910 620 420 680 680 250 630 1.360 610 * 950 290 260 1. They cannot be compared with previous years’ estimates to determine cancer incidence trends. Mortality Public Use Data Tapes.300 110 63.830 240 230 60 * 1. 2006.180 4.150 290 270 70 * 1. numbers are small and NCI and ACS are having difficulty fitting them into the Pickle et al.410 560 * 740 230 230 930 70 300 50 350 1.200 350 4.S. total because of rounding and exclusion of estimates that are fewer than 50 cases. American Cancer Society. Numbers are rounded to the nearest 10.. LEUKEMIA LYMPHOMA MYELOMA page 15 .550 * * * * *20 * * * * 60 * * * 50 * * * * * * * * * * * * * * * * * * 70 * * 50 * * 60 * * * * 80 * * * * * * * 390 Table 11: Sources: Cancer Facts & Figures 2007. is described by Pickle et al. Note: These estimates are offered as a rough guide and should be interpreted with caution.070 110 1.030 570 * 610 210 360 1.240 740 80 1.070 Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist.370 250 280 2. and additional data supplied by the American Cancer Society. *Estimate is fewer than 50 cases.S.660 210 * 190 120 1.610 670 610 110 60 3.040 70 44. 2007. by State. 2007.790 330 * 320 200 1.550 2.170 480 1.Estimated New Cases of Blood Cancers by Site. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Total** 350 * 400 240 2.610 150 2.050 140 140 * * 680 310 * 50 440 240 130 120 170 180 60 220 250 420 190 110 240 50 70 80 50 270 70 650 360 * 460 120 160 550 * 200 * 270 720 70 * 250 220 70 200 * 10. National Center for Health Statistics.S.240 170 550 130 800 3. Used with permission.300 470 90 100 750 430 300 220 290 310 110 320 420 660 350 170 500 80 110 130 90 600 120 1.130 300 80 900 960 300 1. American Cancer Society. The method of derivation.500 430 1. **State estimates may not add up to U.190 880 870 170 100 4.140 380 140 1.510 500 60 70 900 380 220 160 280 430 100 370 460 730 310 170 400 70 110 120 80 650 120 1. total because of rounding and exclusion of estimates that are fewer than 50 cases.710 570 500 2. 2007 State Leukemia Non-Hodgkin Lymphoma Myeloma Hodgkin Lymphoma*** Estimated Deaths from Blood Cancers by Site. 1969-2004. **State estimates may not add up to U. ***Hodgkin lymphoma estimates are not available for 2007.370 100 * 430 380 130 350 * 19.140 60 260 80 410 1.360 960 170 220 2.540 1.330 260 780 180 1. Note: These estimates are offered as a rough guide and should be interpreted with caution.310 800 600 900 920 330 1.080 600 7. 2007 State Leukemia Non-Hodgkin Lymphoma Myeloma Hodgkin Lymphoma Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist.670 1.160 1. which is new for 2007. Table 12: Sources: Cancer Facts & Figures 2007. CA A Cancer Journal for Clinicians. Centers for Disease Control and Prevention.560 770 890 3.010 1.
prevalence numbers reported may vary depending upon the method used to determine them. cancer or otherwise. 2007. complete prevalence is reported as defined by SEER as “an estimate of the number of persons (or the proportion of population) alive on a specified date who had been diagnosed with the given cancer. The American Cancer Society projects this year’s estimated cancer cases and deaths based on incidence rates for 1995 to 2003 from 41 states (approximately 86 percent of the estimated U.” We are using the “29-year limited duration” prevalence figures. The description of the methods used was published in Pickle et al. The data presented in this report are an extrapolation or estimate of the number of cases reported by the 17 Surveillance. Age-adjusted rate is an incidence or mortality rate that has been adjusted to reduce the effects of differences in the age distributions of the populations being compared.S. if a person is initially diagnosed with melanoma and later develops leukemia. It includes new (incidence) and preexisting cases and is a function of both past incidence and survival. race and ethnicity in various regions and region-specific health risks. Census. In some prevalence statistics. Relative survival rate is an estimate of the percentage of patients who would be expected to survive the effects of the cancer.S. This rate is calculated by adjusting the observed survival rate so that the effects of causes of death other than those related to the cancer in question are removed. survival and mortality have been revised. race or sex. These numbers are extrapolated to the entire 17 SEER regions by dividing the number of cancer cases or deaths in a specific region by the U. population) that belong to the National Program of Cancer Registries.” as per SEER table I-21. The SEER (17 region) data cover only about 26 percent of the U. the American Cancer Society changed its method of estimating cancer incidence. Because of this change in method.) Prevalence is the estimated number of people alive on a certain date in a population who previously had a diagnosis of the disease. Incidence rates can be calculated based on a number of factors such as age. only the first diagnosed cancer counts. Epidemiology and End Results Program (SEER) regions (or. Because of changes in the information — such as racial classification — gathered in the 2000 U. This year. so the exact number of cases is not known. Because of reporting delays from some of the SEER regions. LEUKEMIA page 16 LYMPHOMA MYELOMA . Thus. CA A Cancer Journal for Clinicians. Thus. The relative survival rate is a comparison of survival to a person who is free of the disease. population. especially in looking at populations in which individuals have had more than one type of cancer. in comparison to the 2002 SEER report. This change means that the 2007 incidence estimates are not comparable with previous estimates for determining cancer incidence trends. Definitions Incidence is the number of newly diagnosed cases for a specific cancer or for all cancers combined during a specific time period. state-by-state data for incidence of Hodgkin lymphoma are not available because these numbers are so small. It considers deaths from all causes. based on the “first invasive tumor for each cancer site diagnosed during the previous 29 years (1975-2003). January/February 2007. it is the number of new cases per standard unit of population during the time period. estimates of cancer incidence. in some cases fewer than 17 SEER regions) and death data from the National Center for Health Statistics. but these figures do not take into account differences in geography. (Observed survival is the actual percentage of patients still alive at some specified time after diagnosis of cancer. The data can be extrapolated for the entire United States by multiplying by the population ratio.. Bureau of the Census’ 2000 population data for that region. mostly upward. In this report. Mortality data reflected in the 2007 SEER report used as a reference reflect data updates from the National Center for Health Statistics from 1975 to 2004. no matter how long ago that diagnosis was.Notes and Definitions Notes The United States does not have a nationwide reporting system or registry for blood cancers.S. may be incomplete in some cases and the data may reflect adjustments that anticipate changes that will occur once the actual data are received.S. When expressed as a rate. his or her survival with leukemia may not be counted in leukemia prevalence statistics. The specified date is 1/1/2004 for the prevalence estimates. the data presented in the 2007 SEER report placed online on April 15. Prevalence may be calculated in a number of different ways.
Feuer EJ. Jemal A.org/cgi/content/full/57/1/30. Epidemiology. 30-42. pp. posted to the SEER Web site 2007. Edwards BK. “A New Method of Estimating United States and State-Level Cancer Incidence Counts for the Current Calendar Year. Feuer EJ. 20-37. O’Leary M. http://caonline. Stock W.amcancersoc. Bethesda. Bleyer A. National Cancer Institute. Nachman J. Howlader N. Clegg L. Cancer Facts & Figures for African Americans 2007-2008. Ries LAG (eds). Trends.cancer. Atlanta: American Cancer Society. Ries LAG (eds). Barr R. Cheson B. Bethesda. Melbert D. 174.TheOncologist. MD.” Hayat MJ. http://www. 12. pp. Howe HL. Ries LAG. MD. Barr R. MD. 1975-2004. 065767. Bleyer A. Barr R. No. NIH Pub. 2007. Horner MJ. No.gov/csr/1975_2004/ LEUKEMIA LYMPHOMA MYELOMA page 17 . and Multiple Primary Cancer Analyses from the Surveillance. CA A Cancer Journal for Clinicians Vol. 2007. 39-51. 065767. and End Results) Cancer Statistics Review. Reichman ME. National Cancer Institute. Ward E. “Cancer Statistics. Ries LAG (eds). O’Leary M.Citations Source Citations Cancer Facts & Figures 2007.” Bleyer A. 06-5767.” Mattano L Jr. Bleyer A. Including SEER Incidence and Survival: 1975-2000. Hachey M. O’Leary M. Including SEER Incidence and Survival: 1975-2000. 2007.” O’Leary M. 2006. Miller BA. “Lymphomas and Reticuloendothelial Neoplasms. and End Results (SEER) Program. In Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age. Eisner MP. Epidemiology. Bethesda. pp. In Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age. Sheaffer J. Mariotto A. “Leukemias. p. January/February. Howlander N. Zou Z. National Cancer Institute.” Pickle LW. 2006. Including SEER Incidence and Survival: 1975-2000. Bethesda. NIH Pub. pp. MD. Keller F. 2006. Edwards BK (eds). NIH Pub. Reichman M. January. Atlanta: American Cancer Society. The Oncologist Vol.com/cgi/content/full/12/1/20. based on November 2006 SEER data submission. 25-38. “Highlights and Challenges. Ross J. http://seer. Shu X-O. In Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age. 57. No. SEER (Surveillance. 2007. National Cancer Institute. Tiwari RC. Barr R. Hao Y. Krapcho M.
leading to better survival rates and prevention measures for patients.000 a year for a total of $150. Translational Research and the Specialized Center of Research (SCOR). The participating scientists may be at different institutions or from any country.000 a year for a total of $550. • Special Fellows in Clinical Research are awarded $60. The SCOR grants also support scientific core laboratories to provide access to innovative technology if required by the participating research programs. are granted each year. Awards go to those groups that best demonstrate the synergy that will occur from their close interaction. Special Fellows and Fellows) pursuing careers and is stratified into two separately reviewed programs in basic or clinical research: Basic Research • Scholars are awarded $110. Translational Research Awards are made for an initial three-year period. lymphoma and myeloma research comprise four review subcomittees.25 million per year over a five-year period. • Special Fellows are awarded $60. lymphoma and myeloma should be encouraged worldwide. lymphoma or myeloma.000 over three years. Career Development Program The Career Development Program supports promising young scientists (Scholars.6 million annually on research. The Specialized Center of Research (SCOR) in Leukemia. diagnosis or prevention in the near term.000 a year for a total of $550. Research Research Grant Programs The Society’s research programs are based on the belief that all scientifically sound approaches toward a cure for. to a total cost of $6.000 per year for three years. treatment or prevention of leukemia. for a total of $600. leukemia. the Society has awarded more than $550 million in research grants. • Fellows are awarded $50. Research grants are awarded in three program areas: Career Development.000 a year for a total of $180.About the Society The Leukemia & Lymphoma Society is the world’s largest voluntary health organization dedicated to funding blood cancer research and providing education and patient services. Lymphoma and Myeloma These center grants are awarded to a cluster of at least three research groups that interact to foster advances in the diagnosis. Hodgkin’s disease and myeloma. They are: 1) Career Development Program (CDP)-basic research. The program is expected to generate new knowledge and breakthrough discoveries.000. Funding for two additional years may be provided for highly promising projects that are entering phase I clinical trial. The Society is a nonprofit organization that relies on the generosity of individual and corporate contributions to advance its mission. 2) CDP-clinical research. 4) Specialized Center of Research Program that evaluate all grant applications in those programs and determine those applicants with the most innovative and LEUKEMIA page 18 LYMPHOMA MYELOMA . and improve the quality of life of patients and their families. 3) Translational Research Program.000 over five years. each focused on the discovery of new approaches to benefit patients or those at risk for developing leukemia. Translational Research Program The Translational Research Program provides early-stage support for research on leukemia. or control of. the Society’s grant programs are among the most prestigious in the fields of blood cancers.000 over three years. lymphoma.25 million. Now supporting $61. lymphoma and myeloma.000 over three years. Thus. We offer a wide variety of programs and services in support of our mission: Cure leukemia. Translational Research • Scholars in Clinical Research are awarded $110.000 a year for a total of $180. lymphoma and myeloma that is intended to advance treatment. The Grant Review Process Scientists and physician-scientists who are experts in the field of leukemia. Each SCOR is funded up to $1. The SCOR program brings together research teams working in complementary areas. research reaching a clinical trial can receive $1 million over five years to facilitate new drug discovery or advances in diagnosis or prevention. Awards up to $200.000 over five years. Since the first funding in 1954.
9 a. the Society’s programs and services. These offices conduct lifeenhancing patient services. from 10:00 a. The Society funds several Focused Workshops each year on important topics relevant to hematological malignancies.org. families. Other meetings are held for the Society’s grantees. Teleconferences and Webcasts The Society sponsors more than 25 educational teleconferences and Webcasts each year on topics of interest to patients and caregivers. Family Support Group locations. serves a wide variety of education and information needs.org or faxing to (914) 949-6691 or contacting the Research Department at (914) 949-5213. As of June 30. Patients needing assistance may apply on the Society’s Web site. lymphoma and myeloma.org or by or emailing researchprograms@LLS. They are available to talk one-onone. peer counseling and patient financial aid. Much of the content of these materials is available to view and download at www. their families and healthcare professionals. 2007 the Society will have 379 active grantees at 116 institutions in the United States and abroad. The educational program offers varying formats to facilitate the exchange of information and ideas on the newest developments in cancer research and treatment. Monday through Friday. Information on registration for these free events can be accessed at www. on the Society’s Web site. Co-Pay Assistance Program Patients with AML. LEUKEMIA LYMPHOMA MYELOMA page 19 . call (877) LLS-COPAY ( 557-2672) or email copay@LLS.LLS.LLS. is held each December on the Friday immediately before the American Society of Hematology meeting. the Translational Research Grant Progress Review Meeting and the SCOR Progress Review Meeting. where medical professionals share the latest research findings. Each year.org. including support groups.important projects to advance the Society’s mission. www. The Society also hosts numerous teleconferences and Webcasts.m. audio. instructions. ET. These include the Stohlman Scholar Symposium. www. The site features a comprehensive overview of blood cancers. myeloma and MDS who have difficulty paying for or simply cannot afford their health insurance premiums or prescription drug co-pays can now apply for assistance from the Society. Guidelines. podcasts and Webcast archives of these programs are available at www. The user has the opportunity to create personalized pages with identified interests.LLS. and applications for the Society’s three research programs may be obtained by visiting www. treatment and prevention of leukemia. Patients. information about our peer-to-peer program First Connection and other programs. friends and healthcare professionals. myeloma. lymphoma. lymphoma. The Society’s Web Site The Society’s Web site.LLS. You may also chat online with an information specialist. Information specialists are oncology social workers and health educators who provide callers with current information on blood cancers. ET.org. sponsored by the Society. Patient Services The Society has a network of 68 chapters throughout the United States and Canada. This support should advance the understanding. brochures and videos through the IRC and local Society chapters. Educational Materials An extensive collection of free educational materials are offered to patients and health professionals. It is continually being updated and expanded to support and promote the Society’s mission. The IRC is a worldwide link to information and resources useful to patients.org. treatments. clinical trials and offer guidance on coping. A trained patient volunteer currently in remission phones the new patient to share information and support. Professional Education The Society serves the continuing educational needs of the medical and research community through professional symposia offered throughout the year.org. www. First Connection: This program links newly diagnosed patients to a peer volunteer who has experienced a similar diagnosis.org. and click “Live Help.m. Guided by two volunteer oncology health professionals. myelodysplastic syndromes (MDS) and other blood cancers. Information Resource Center (IRC) The Society strives to be the world’s foremost source of information on leukemia. to 6 p. to 5:00 p. The Annual Research Symposium.org. families and professionals may call the IRC toll free at (800) 955-4572 in addition to corresponding by email at infocenter@LLS.org/copay.LLS. each group provides information and support. and encourages greater communication among patients.” Chapter Programs: Family Support Groups: The Society has developed more than 360 Family Support Groups at 68 chapters.m.m.LLS. the Society distributes more than 1 million booklets.LLS.
In 2001. the Society has successfully ensured coverage of routine care in cancer clinical trials in three states and secured additional funding for patient support programs in four others. treatments.and long-term effects that children may experience after treatment. This nursing education program provides an overview of CML. This Society program is being supported by Celgene Corporation and Millennium Pharmaceuticals. Patient financial aid funds are subject to availability. Welcome Back: Facilitating the Return to School for Children with Cancer: A new addition to The Trish Greene Back to School Program. This program is provided through an unrestricted educational grant from Millennium Pharmaceuticals. Accessing the Best Cancer Treatment at Any Age: This education program presents an overview of the many factors (not age alone) that healthcare professionals should assess to determine an appropriate cancer treatment plan for an older adult. families and healthcare professionals with a clear description of what clinical trials are. Department of Defense’s medical research program. CML Issues and Insights: A Nursing Education Program on Chronic Myelogenous Leukemia. In 2002. The Trish Greene Back to School Program for Children with Cancer: This program is designed to increase communication among healthcare professionals. emerging therapies and side effects and addresses the unique challenges of nursing management of these patients. The Society has identified key issues that currently shape its advocacy agenda. New Directions in Myeloma Therapy: This program presents an overview of myeloma. Printed literature. and offers numerous resources that can assist childhood cancer survivors to flourish in the school environment posttreatment. the Society has helped patients demonstrating a need for financial assistance cover a portion of their treatment costs. lymphoma and myeloma. this education program discusses possible emotional and cognitive short.Patient Financial Aid Program: For more than 31 years. local volunteers and staff are building a grassroots advocates’ network to rally patients and their families to promote common goals related to cancer research and treatment. the Society successfully lobbied Congress to institute a blood cancer research initiative as part of the U. Meet the Expert on Non-Hodgkin Lymphoma: This program presents basic information on terminology. That network now numbers more than 35. treatments. videos and other materials to aid the process are available through all local chapters. The patient education program was funded at $18 million through 2007. the Society successfully lobbied Congress for legislation that authorizes a new blood cancer research effort at the NCI and creates a new blood cancer education program for patients and the public under the Centers for Disease Control and Prevention. staging and classification of nonHodgkin lymphoma (NHL). risk factors. representing to policy makers at all levels of government the healthcare quality concerns and medical research interests of patients and their families. how cancer drugs are developed and what the emerging treatment options are for leukemia. emerging therapies and managing side effects and how to find emotional support when living with the illness.org and is being sponsored by a generous.LLS. unrestricted educational grant from Genentech BioOncology and Biogen Idec Inc. DC. patients and school personnel to assure youngsters a smooth transition from active treatment back to school. On the state level. that program has funded some $30 million in additional blood cancer research. Working through chapters across the country. The Path to Progress: Clinical Trials in Blood Cancers: This program provides patients. It is supported by Amgen Oncology. This program is being sponsored by an unrestricted education grant from Novartis Oncology. parents. New insights. This program is also accessible as a Webcast at www. treatments and future directions for NHL are also discussed.000 and has become a potent voice in public policy deliberations. Society volunteers and staff visit Capitol Hill regularly to lobby Congress in support of issues that impact research and patient care. including • Insurance coverage of patient-care costs in clinical trials • Ready access by all Americans to quality cancer care • Increased funding for the National Institutes of Health and National Cancer Institute (NCI) • Increased funding for blood cancer research at other federal institutions • Federal funding for patient education and support programs. reimbursement of up to $500 per year helps cover the costs of transportation. This program is made possible by the Lance Armstrong Foundation. diagnosis. LEUKEMIA page 20 LYMPHOMA MYELOMA . Through the Patient Financial Aid Program. the Society’s advocacy program has been a strong voice in Washington. Advocacy Since 1994. To date.S. providing additional support for blood cancer patients and their families nationwide. drugs and various treatments not covered by insurance.
NCI. . provided ACS’s state-by-state statistics on myeloma and Hodgkin lymphoma.seer. This publication is designed to provide information in regard to the subject matter covered. of the American Cancer Society (ACS). Ph.gov.Acknowledgements Additional data from SEER*Stat Databases at http://www. for compilation of data for this publication. The Leukemia & Lymphoma Society extends special thanks to Myrna Watanabe. and Rebecca Siegel. provided statistical assistance.cancer. with the understanding that the Society is not engaged in rendering medical or other professional services. Milton Eisner of SEER.D. It is distributed as a public service by The Leukemia & Lymphoma Society Inc..
4572 www.955. New York 10605 Tel: 888.LLS. and improve the quality of life of patients and their families.Home Office 1311 Mamaroneck Avenue. The Society is a nonprofit organization that relies on the generosity of individual. Suite 310 White Plains. lymphoma. corporate and foundation contributions to advance its mission.LLS Information Resource Center (IRC): 800.org Our mission: Cure leukemia. PS80 35M 6/07 . Hodgkin’s disease and myeloma.HELP.
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