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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.
070 from Hodgkin. www. and myeloma. National Cancer Institute.520 people in the United States will be diagnosed with leukemia.cancer. More males are diagnosed with leukemia and more males die of it than females.790 people will die from myeloma. is a compilation of the most recent data on leukemia.4 percent of the 1. 19. lymphoma and myeloma will cause the deaths of an estimated 52.349 Americans are living with leukemia. lymphoma and myeloma. lymphoma and myeloma decreased from 1995 to 2004 (the last year data were available).240 people will be diagnosed with leukemia. 19. • Non-Hodgkin lymphoma is the fifth most common cancer in the United States.1975-1977 vs.190 cases of Hodgkin.313 either have or are in remission from Hodgkin lymphoma. LEUKEMIA LYMPHOMA MYELOMA page 1 . someone dies from a blood cancer. Myeloma: • • • • There are 60. 405. The next SEER Cancer Statistics Review is expected to be published online in April 2008. 138.seer.660 from non-Hodgkin). *except acute myelogenous leukemia (AML) and other. *Myeloma Biology and Management.953 either have or are in remission from non-Hodgkin lymphoma (NHL). These data were published online by SEER. This year.444. and its age-adjusted incidence rose by nearly 84 percent from 1975 to 2004. the incidence of myeloma increased 8 percent.790 people will die of leukemia. This year. • This year.266 people living today with lymphoma. an annual publication. 1960-1963 1975-1977 1996-2003 Figure 1: Sources: SEER (Surveillance. 2nd Edition. Deaths • Leukemia. 1996. National Cancer Institute.3 percent of the deaths from cancer in 2007 based on the 559. Five-Year Relative Survival Rates 1960-1963 vs. 1975-2004. 1998.900 people will be diagnosed with myeloma.659 people in the United States who are either living with or are in remission from leukemia. Epidemiology and End Results Program.gov. nonacute myelogenous and monocytic leukemias Lymphoma: • There are 544.Executive Summary Facts 2007-2008. lymphoma and myeloma in 2007. 18. • Eighty-six percent of myeloma cases occur in people aged 55 and over. page 16). 71. Highlights from the Report Include: New Cases • An estimated 135. From 1975 to 2004. Leukemia.424 people living today with myeloma. This statistic represents 143 people each day.650 total cancer-related deaths. • This year. the likelihood of dying from most leukemias*. • Leukemia causes more deaths than any other cancer among children and young adults under the age of 20. • In general. the National Cancer Institute’s Surveillance. in April 2007. Mortality from the disease increased 24 percent.190 cases of non-Hodgkin). This abnormal accumulation interferes with the production of healthy blood cells. • Every five minutes. • Every 10 minutes. or nearly six people every hour. Oxford University Press. which becomes malignant and multiplies continuously. 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. someone is diagnosed with a blood cancer. Epidemiology and End Results) Cancer Statistics Review. Survival • An estimated 823. The data within Facts 2007-2008 reflect the most recent statistics available from SEER. Cancer Statistics Review 1975-2004 (see Notes. 2007 and SEER 19731993. Hodgkin and non-Hodgkin lymphoma. 21. 63. 44.920 new cancer cases diagnosed in the United States this year. Hodgkin and non-Hodgkin lymphoma and myeloma will account for nearly 9. • These blood cancers will account for 9.730 people will die from lymphoma (1. • In 2007. • New cases of leukemia.310 people in the United States this year. • In 2007. 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. • Thirty-two percent more males are living with leukemia than females. 10.380 new cases of lymphoma will be diagnosed in the United States (8.
Estimated New Cases (%) of Blood Cancers in 2007 Myeloma 15% Leukemia 33% Lymphoma 53% Treatment Chemotherapy and Radiotherapy: The use of chemotherapy (anticancer drugs). Such an approach would greatly lessen the proportion of children without a donor. Research is being conducted to improve socalled “haploidentical” transplant. Autologous transplantation uses the patient’s own marrow stem cells and is technically not transplantation since another person is not the donor. The blood or marrow stem cells are collected while the patient is in remission. studies suggest that two matched cord donors may result in a higher success rate in larger adults. Patients with acute lymphocytic leukemia (ALL). 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. usually a brother or sister with the same tissue type. freezing and storing of cord blood have provided another source of stem cells for transplantation. some types of Hodgkin lymphoma. 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. The accumulation of malignant cells interferes with the body’s production of normal blood or immune cells and can result in severe anemia. decreased ability to fight infections and a predisposition to bleeding. American Cancer Society. especially for children. Hodgkin and non-Hodgkin lymphoma and myeloma are cancers that originate in a cell in the bone marrow or lymphatic tissues. which becomes abnormal (malignant) and multiplies continuously. a search of the National Marrow Donor Program registry of tissue-typed volunteers could be made for a matched unrelated donor. 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. In special instances. myeloma and lymphoma are usually treated with chemotherapy. is largely responsible for the dramatic improvement in managing leukemia and lymphoma. An allogeneic transplant uses blood or marrow stem cells from a normal 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. 2007. Patients with leukemia. usually in combinations of two or more drugs. lymphoma and myeloma. Approximately 50 different drugs are now being used in the treatment of these diseases. 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. 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. slightly mismatched cord stem cell donors may be used quite successfully. especially in young children. These diseases usually result from an acquired genetic injury to the DNA of a single cell. The technique is important. There are two major types of stem cell transplants: syngeneic and allogeneic. However. If a sibling is not available. Syngeneic transplant describes the use of an identical twin as donor.) of larger adult patients. Stem cells also circulate in large numbers in fetal blood and can be recovered from umbilical cord and placental blood after childbirth. 2007. (Numbers do not add up to 100% because of rounding. 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.About the Diseases Leukemia. The harvesting.
Follow-Up Care Regular medical follow-up enables doctors to assess the full effect of therapy. Adolescent. donors of blood stem cells require special treatment to mobilize sufficient stem cells from marrow into their blood before cells are harvested. these cells can be harvested from the blood of a donor. To ensure there will be enough blood stem cells for successful transplantation. Cancers (http://www. In standard stem cell transplantation. several important new drugs and new uses for existing drugs have greatly improved cure rates or remission duration for some patients with leukemia. but some follow adult cancer survivors. In nonablative transplantation. Stem cells not only reside in the marrow but also circulate in the blood. Gleevec offers several dramatic advantages to patients: oral administration. 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.org/). or genetic factors that can increase susceptibility to certain effects. This “graft versus leukemia or lymphoma effect” can suppress (cure) the malignancy and is a prolonged (indefinite) form of immunotherapy. is a source of stem cells for transplantation. making the procedure more tolerable. Over time. Imatinib mesylate (Gleevec®) is now the drug of choice in newly diagnosed patients with chronic myelogenous leukemia (CML). Follow-Up Guidelines: The Children’s Oncology Group has established Long-Term Follow-Up Guidelines for Survivors of Childhood. as well as marrow. two second-generation agents.patients. Regular examinations may include screening for cancer recurrence or the development of secondary cancer or other late effects of treatment. multi-disciplinary approach to monitoring and supporting cancer survivors. This still experimental approach greatly lessens the early toxicity of transplantation and has extended the age at which recipients with leukemia.childrensoncologygroup. 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. marrow and immune system. the recipient’s blood cell and immune system are preserved. Coordination between specialists and primary care physicians is essential to provide the best care possible. 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. and Young Adult LEUKEMIA LYMPHOMA MYELOMA page 3 . “Ablation” referred to wipingout the recipient’s cancer. Development of New Drugs: In the past decade. the donor’s cells take hold and the patient’s leukemia. identify recurrence of the disease and detect long-term or late effects. lymphoma or myeloma is attacked and suppressed by donor lymphocytes that form from the donor stem cells. Cancer survivors should see their primary care physicians for general health examinations and an oncologist for follow-up care related to cancer. Some treatment centers have follow-up clinics that provide a comprehensive. Blood and cord blood transplants differ from marrow transplants principally in the source of the cells collected for transplant. 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. “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. Because blood. ablation of the recipient’s blood-cell forming and immune cells was the price that had to be paid to eradicate the leukemia. thereby allowing doctors to plan treatment accordingly. New Approaches to Treatment Several areas of research have resulted in new approaches to the treatment of leukemia. Cancer survivors should have physical examinations yearly or more often. as needed. lymphoma or myeloma can have an allogeneic transplant. Most follow-up clinics specialize in pediatric cancer survivors. lymphoma and myeloma. lymphoma or myeloma and permit the donor’s cells to be accepted by the temporarily immunodeficient recipient. Identifying these biomarkers will allow researchers to develop tests that can predict what effects an individual is at risk of developing. Although a minority of patients have developed resistance to the drug. few severe adverse effects on normal tissues and a very high response rate. frozen and stored and later transplanted in the patient. It works by blocking the oncogeneencoded protein product that instigates the transformation to a leukemic cell. Biomarkers could be high levels of certain substances in the body such as antibodies or hormones.
Indeed. 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. it has now become an important fifth drug in the R-CHOP–rituximab. although initially used in indolent lymphomas. and Decitabine (Dacogen®). This drug is also being tested in clinical trials to treat adult acute leukemia and MDS. 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.dasatinib (Sprycel®)(approved by the U. Monoclonal antibodies have added to the arsenal of agents that are used for the treatment of patients with lymphoma and leukemia. the most prevalent lymphoma subtype. approved by the FDA for all types of MDS. Clofarabine (Clolar®). Early studies indicate the combination of arsenic trioxide and all-trans retinoic acid may be a further advance in the initiation of therapy. 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®). Three types of immunotherapy are being explored: antibody treatment. thus rituximab is an anti-CD20 antibody. Alemtuzumab (Campath®) is a monoclonal antibody directed against the antigen CD52 found on T and B lymphocytes. thalidomide (Thalomid®). perhaps 20 percent of cases also derive benefit. vincristine (Oncovin®) and prednisone–therapy for diffuse large B-cell lymphoma. 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. LEUKEMIA page 4 LYMPHOMA MYELOMA . kill unhealthy bone marrow cells and may help the bone marrow function more normally in MDS patients. however. Some patients with moderately severe. is being used to treat relapsed or refractory acute lymphocytic leukemia (ALL) in children who have received at least two prior therapies. but it can also induce remissions in some cases of acute leukemia. 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). lymphoma or myeloma. was approved by the FDA for newly diagnosed myeloma. such as follicular lymphoma. farnesyl transferase inhibitors and reduced-intensity stem cell transplantation. 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. Lenalidomide (Revlimid®). Revlimid is approved by the FDA in combination with dexamethasone for the treatment of myeloma patients who have received at least one prior therapy. a thalidomide derivative. It is especially active against the lymphocytes in CLL. In patients with anemia. The treatment of hairy cell leukemia. reducing the need for transfusions in some patients. Immunotherapy: This is a treatment that uses immune cells or antibodies to fight the disease. principally. doxorubicin (Adriamycin®). Velcade is approved by the FDA for treating people with myeloma who have had at least one prior therapy. PDGFR or KIT oncoproteins). chronic eosinophilic leukemia (formerly hypereosinophilic syndrome). Pentostatin is another effective drug that can be used in patients with hairy cell leukemia who do not respond to cladribine. Patients with more severe forms of MDS are very unlikely to respond to the agent. has improved dramatically with the introduction of cladribine. and enhances the specificity of treatment to minimize toxic effects on normal tissues. Rituximab is an antibody directed at the target CD20 antigen on B-cell lymphoma cells. Food and Drug Administration [FDA] in 2006) and nilotinib (in clinical trials). but without this specific chromosome 5 abnormality. Rituximab has become an important agent to treat CD20-positive lymphocytic malignancies. In May 2006. in combination with dexamethasone. immune cell administration and vaccine development. Arsenic trioxide also adds to the drugs available to treat this subtype of acute leukemia.S. are entering clinical use and can overcome this resistance in some cases. Other therapies in clinical research to treat MDS include arsenic trixoxide. approved by the FDA in 2005. Cladribine induces long-term remissions in nearly 90 percent of patients treated at diagnosis for one week. suppresses the progression of leukemia. cyclophosphamide. Gleevec is not only a very important new agent in the treatment of CML. symptomatic anemia have improvement in hemoglobin levels with this agent. a less common type of chronic lymphocytic leukemia (CLL). Monoclonal Antibody Therapy: Monoclonal antibodies are laboratory-produced proteins that can be infused into an appropriate patient. Cell surface antigens have been given a cluster designation (CD) followed by a number. Azacitidine (Vidaza®).
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. They deliver the toxic substance directly to the cancer cells. 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. The goal of several new agents being studied is to decrease resistance to an important chemotherapy drug used in leukemia. These are called conjugated monoclonal antibodies. Studies of vaccines used in patients with follicular or indolent lymphoma have demonstrated an immune response. Paradoxically. The goal is to extend the duration of remission achieved by remissioninduction therapy of various types. In each case. a technique that prepares small molecules in the laboratory that have the ability to inactivate proteins that cause disease. Approaches to reversing multidrug resistance are under study. An alternative strategy called molecular targeted drug development targets the oncoprotein. Two new and potentially important approaches include a) the application of RNA interference. new forms of cancer therapy may be developed. lymphoma and myeloma. less responsive to therapy. Many cancer treatment vaccines under development are intended to induce antigen-specific antitumor immune responses. myeloma and leukemia. In another approach. These cells are. Vaccines are in clinical trials for types of acute and chronic leukemia. the infusion of the original marrow donor’s lymphocytes can re-induce remission. This drug. In some approaches. In patients with CML who have relapsed after stem cell transplantation. 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. Monoclonal antibodies can also be linked to a radioactive isotope to target and kill specific cancer cells. 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. These drugs have been approved to treat relapsed B-cell non-Hodgkin lymphoma. In studies of CML. Reversal of Multidrug Resistance: The malignant cells of patients have mechanisms that may allow them to escape the damaging effects of chemotherapy agents. the patient’s immune cells would be treated in the laboratory to train them to attack the residual leukemia. gemtuzumab (Mylotarg®). 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. LEUKEMIA LYMPHOMA MYELOMA page 5 . Vaccines: Experimental treatment vaccines are now being studied to treat certain types of lymphoma. some vaccines are made from leukemic cells treated in test tubes to convert them to potent antigen-presenting cells. cells are isolated in the laboratory and start making antibodies after insertion of the cancer antigen. Examples of this treatment are the drugs ibritumomab (Zevalin®) and tositumomab and iodine I131 tositumomab (Bexxar®). These types of vaccines would be used in patients who have small amounts of residual blood cancer after chemotherapy or stem cell transplantation. 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. b) a modality that uses molecules of RNA to silence complementary (DNA) genes. lymphoma or myeloma cells. If the gene in the former case is an oncogene or the protein in the latter case is an oncoprotein. 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. or become. is approved for older patients with AML who relapse after initial treatment. gene therapy researchers are trying to modify an oncogene (BCR-ABL) that produces a protein that stimulates malignant cell growth. In one approach. and aptamer treatment. Patients with myeloma have also had remission re-induced by donor lymphocytes. 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. This means that the vaccine induces an immune response against the cancer cells present in the patient. DNA vaccines that contain the DNA that encodes the specific antigen are being tested.
The lack of normal white cells impairs the body’s ability to fight infections. Chronic leukemias account for 7 percent more of the cases than acute leukemias.S.150 24. *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. Statistical Research and Applications Branch. and SEER Program.240 new cases of leukemia will be diagnosed in the United States this year.200 15.579 21. Chronic leukemia progresses more slowly and allows greater numbers of more mature. Surveillance Research Program. Leukemia is divided into four categories: myelogenous or lymphocytic. LEUKEMIA page 6 LYMPHOMA MYELOMA . 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 218.289 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. 1. Only 2. Incidence by Gender Incidence rates* for all types of leukemia are higher among males than among females.960 7. Estimated 29-Year L-D Prevalence Counts on 1/1/2004 by Duration.060 2. Prevalence of the Four Major Leukemias as of Jan. functionless cells in the marrow and blood.350 2.189 27. DCCPS. In 2007.570 19. each of which can be acute or chronic. Nearly 54 percent of the new cases of this disease will occur among children in 2007 (about 2. Leukemia is expected to strike more than 10 times as many adults as children in 2007. functional cells to be made.410 4. The terms myelogenous or lymphocytic denote the cell type involved. Prevalence database: U.570 3.659 people in the United States are living with leukemia. Approximate U. aged 0-19. The marrow often no longer produces enough normal platelets.380 6. National Cancer Institute.501 50.790).4 percent of leukemias in children aged 0-19 are CML. red blood cells and white blood cells. Acute leukemia is a rapidly progressing disease that results in the accumulation of immature.060 8.570 5. • Most cases of leukemia occur in older adults.340 13.720 44.000 population. American Cancer Society. 2007. Epidemiology. The incidence rates are usually presented as a specific number per 100. Table 3: Source: Cancer Facts & Figures 2007. The four major types of leukemia are shown in Table 1.S. • About 33 percent of cancers in children aged 0-14 years are leukemia • Most cases of chronic myelogenous leukemia (CML) occur in adults.800 children. based on the November 2006 SEER data submission. 2004 Type Chronic lymphocytic leukemia Chronic myelogenous leukemia Acute lymphocytic leukemia Acute myelogenous leukemia Prevalence* 95. develops in virtually all leukemia patients. *Note: Incidence rates are the number of new cases in a given year not counting the preexisting cases. 2007. males are expected to account for 56 percent of the new cases of leukemia.800 Female 2. more than half of all cases occur after age 67. and End Results) Cancer Statistics Review 1975-2004.Leukemia Leukemia is a malignant disease (cancer) of the bone marrow and blood.000 2. New Cases An estimated 44. (About 40. Anemia.240 Male 3.440 adults compared with 3.140 6.440 Table 2: Sources: SEER (Surveillance. a deficiency of red cells. NCI. It is characterized by the uncontrolled accumulation of blood cells. released April 2007. A shortage of platelets results in bruising and easy bleeding. • The most common form of leukemia in children is acute lymphocytic leukemia (ALL).) • The most common types of leukemia in adults are acute myelogenous leukemia (AML) and chronic lymphocytic leukemia (CLL).
However.5 times that of ALL. eighth and ninth decades of life.619 with ALL. In the 17 SEER regions of the United States. was 504 per 100. there were 4.000 population. The diagnosis of leukemia requires specific blood tests. 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. It is estimated that in 2007. American Cancer Society. The most common form of leukemia among children under 20 years of age is ALL. CML incidence also increases dramatically among people who are aged 60 and older.922 cases per year. The incidence rate for all cancers among AfricanAmericans in the Seer (17 region).to 4-year-old children is more than nine times greater than the rate for young adults ages 20 to 24. These signs are not specific to leukemia and may be caused by other disorders. Most children under 15 years of age with ALL are cured. and AML incidence increases dramatically in people who are aged 60 and older.Estimated Proportion of New Cases (%) in 2007 for Each Type of Leukemia Including Adults and Children 3.to 29-year olds. Adults. AML incidence was approximately 1. Incidence by Age-Group Incidence rates by age differ for each of the leukemias. 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. LEUKEMIA LYMPHOMA MYELOMA page 7 . Figure 3: Source: Cancer Facts & Figures 2007. In 25. leukemia rates are higher in Americans of European descent than among those of African descent. Leukemia rates are substantially higher for Hispanic.800 children will be diagnosed with leukemia throughout the United States. neither explains most cases. Some people with chronic leukemia may not have major symptoms and are diagnosed during a medical examination. From 1975 to 2000. Among 15. 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. Although chronic exposure to benzene in the workplace and exposure to extraordinary doses of irradiation can be causes of the disease. from 2000-2004. 2007.900 new cases of cancer diagnosed in African-Americans in 2007. The leukemias represented 27 percent of all cancers occurring among children younger than 20 years from 2000-2004. They do warrant medical evaluation.790 new cases of childhood ALL are expected to occur in 2007. including 3. the incidence of AML slowly rose while that of ALL steadily decreased in the period from late adolescence to older adulthood. 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). Possible Causes of Leukemia Anyone can get leukemia. including the examination of the cells in blood or marrow. About 2. ALL incidence was approximately twice that of AML. The cause of leukemia is not known. These cancers are most prevalent in the seventh. Leukemia strikes all ages and both sexes. The American Cancer Society estimates that there will be approximately 152. Adolescents and Young Adults. American Indian/Alaskan natives.799 children under the age of 20 diagnosed with leukemia from 2001-2004.to 19-year olds. Leukemia incidence is highest among whites and lowest among American Indians/Alaskan natives. Children. Leukemia is one of the top 15 most frequently occurring cancers in minority groups. The incidence of ALL among 1. white and Asian/Pacific islander children than for black children. averaging about 189.
8 1-4 0.3 3. the overall relative survival rate was nearly 50 percent.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 1.4 5-9 0. Epidemiology and End Results) Cancer Statistics Review 1975-2004.9 20-24 0. when compared to a person without leukemia. 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.3 percent overall.9 25-29 1. LEUKEMIA page 8 LYMPHOMA MYELOMA .6 2.1 for children under 15 • CML: 44.2 15 13 11 9 7. All Types Leukemia. 2007.4 percent Five-Year Relative Survival Rates for All Ages.2 10.6 10-14 0.4 <1 0.4 percent for children under 5 • CLL: 74. a patient had a 14 percent chance of living five years. The five-year relative survival rate has more than tripled in the past 47 years for patients with leukemia.9 15-19 0. Complete remission means that there is no evidence of the disease and the patient returns to good health with normal blood and marrow cells.8 percent • AML: 20. the five-year relative survival rates overall were: • ALL: 65. National Cancer Institute. race and type of leukemia.1 Incidence (per 100. For acute leukemia. 90.2 23 21 19 19. Treatment centers report increasing numbers of patients with leukemia who are in complete remission at least five years after diagnosis of their disease. In 1960-1963.5 21. and in 1996-2003.1 4. Thirty-two percent more males than females are living with leukemia.7 percent overall. Treatment of Leukemia The aim of treatment is to bring about a complete remission. During 1996-2003.000) 17 15. 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. Epidemiology and End Results) Cancer Statistics Review 1975-2004. National Cancer Institute. The relative survival rates differ by age of the patient at diagnosis. 2000-2004 25 23.Age-Specific Incidence Rates for Acute Myelogenous Leukemia (All Races). By 1975-1977. 54. a complete remission (no evidence of disease in the blood or marrow) that lasts five years after treatment often indicates cure. 2007.7 7 5 3 1 0 1. the five-year relative survival rate had jumped to 35 percent. Relapse indicates return of the cancer cells and the return of other signs and symptoms of the disease. gender.3 1.
There will be an estimated 4.320 males and 9. Despite this decline. Cancer Statistics Review. 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.710 9.940 3.020 240 3. Sources: 1.Five-Year Relative Survival Rates for Acute Lymphocytic Leukemia. In 2007.990 deaths from AML and 490 deaths from CML. Epidemiology and End Results). 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. SEER (Surveillance.500 8.420 4.390 21. LEUKEMIA LYMPHOMA MYELOMA page 9 . 2. Non-Hispanic whites diagnosed with leukemia over the age of 44 had the highest death rates during this period. 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.790 Male 820 2. unclassified forms of leukemia Total Overall 1. 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. Hispanics with leukemia who are under the age of 25 had the highest mortality rates from the disease between 1990 and 1999. 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. Blood.470 females.970 250 2. deaths from leukemia are expected to be distributed in the following numbers: In 2007.680 12.420 deaths from ALL. American Cancer Society. National Cancer Institute. Deaths It is anticipated that approximately 21. in Children Under 15 Years of Age. 1964:24:477-494.470 Table 4: Source: Cancer Facts & Figures 2007. 1975-2004. 2007.500 deaths from CLL and 1.560 5. Zuelzer WW. In 2007. leukemia will be the fifth most common cause of cancer deaths in men and the sixth most common in women. about 515 children under the age of 14 are expected to die from leukemia. Unclassified forms of leukemia will account for 6. Implications of long-term survivals in acute stem cell leukemia of childhood treated with composite cyclic therapy. 2007.320 Female 600 1. leukemia causes more deaths than any other cancer among children and young adults under age 20.790 deaths in the United States will be attributed to leukemia in 2007: 12.390 additional deaths. There will be an estimated 8.990 490 6.
or low. including the presence of an abnormal cell called the ReedSternberg cell (a large. Age-specific incidence rates of non-Hodgkin lymphoma are 2.953 people living with nonHodgkin lymphoma for a total of 544. The incidence of Hodgkin lymphoma is consistently lower than that of non-Hodgkin lymphoma.190 63. in general whites have higher incidence rates than blacks. LEUKEMIA page 10 LYMPHOMA MYELOMA . The groups are often classified as indolent or aggressive.190 71. By ages 60 to 64.200 38. intermediate and high grade. The reasons for the development of non-Hodgkin lymphoma are not certain.710 Total 8.380 Americans will be diagnosed with lymphoma in 2007 (8. population who are living with lymphoma. 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.000 for females. and each has prognostic factors that categorize it as more or less favorable. Non-Hodgkin lymphoma is the fifth most common cancer in males and females in the United States. malignant cell found in Hodgkin lymphoma tissues).380 Table 5: Source: Cancer Facts & Figures 2007. the difference was small. Incidence by Gender Table 5 illustrates the breakdown of incidence of lymphoma by gender. These risk factors explain only a small proportion of cases. Persons infected with the human immunodeficiency virus (HIV) have a much higher risk of developing lymphoma.S.Hodgkin lymphoma are higher in Americans of European descent than among those of African descent.266 members of the U. Living with Lymphoma In the United States in 2007.9 per 100.8 percent. Fifty-three percent of the blood cancers diagnosed are lymphomas. Hodgkin Lymphoma Hodgkin lymphoma is a specialized form of lymphoma and will represent about 11. eventually crowding out healthy cells and creating tumors that enlarge the lymph nodes or other sites in the body. New Cases About 71. Each histologic grouping is diagnosed and treated differently. In 2004. an average annual percentage increase of 2. The bacterium Helicobacter pylori is associated with the development of lymphoma in the stomach wall.720 28. 2007. Incidence rates for Hodgkin lymphoma tend to be higher among males than among females.000 at ages 20 to 24 for males and 1. After 50 to 54 years of age.190 cases of non-Hodgkin lymphoma).670 Female 3. The Epstein-Barr virus causes Burkitt’s lymphoma in Africa.990 32. New Cases of Lymphoma by Gender. Hodgkin lymphoma has characteristics that distinguish it from all other cancers of the lymphatic system. 2007 Type Hodgkin lymphoma Non-Hodgkin lymphoma Total Male 4. rose by 84 percent from 1975 to 2004.313 people living with Hodgkin lymphoma (active disease or in remission) and 405.470 34. while 0. Immune suppression plays a role in some patients. More than four percent of all cases of Hodgkin lymphoma diagnosed in 2007 will be in children under 15 years of age.Lymphoma Lymphoma is a general term for a group of cancers that originates in the lymphatic system. there are 138.190 cases of Hodgkin lymphoma and 63.3 per 100.7 percent of all cases of non-Hodgkin lymphoma will be diagnosed in children under 15 years of age this year. Both Hodgkin and non-Hodgkin lymphomas are more common in males than in females.9 per 100.6 per 100. Lymphoma results when a lymphocyte (a type of white blood cell) undergoes a malignant change and begins to multiply.000 for males and 38.000 for females. they are 52.5 percent of all lymphomas diagnosed in 2007. incidence rates for non. 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. It is the sixth most common cause of cancer deaths in males and in females. American Cancer Society.
It has remained fairly constant since 1999.000 children in 2004. sweating at night. Hispanics of all races have the second highest incidence rates of non-Hodgkin lymphoma after whites. Adolescents are more commonly diagnosed with Hodgkin lymphoma than young children. lymphomas are most commonly diagnosed in whites (24. The most common early sign of other forms of lymphoma is also painless swelling of the lymph nodes – usually in the neck. Survival for Adults Hodgkin lymphoma is now considered to be one of the most curable forms of cancer.000 persons at ages 80 to 84. depending on the tumor size.660 from non-Hodgkin lymphoma. Lymphomas (Hodgkin lymphoma. 4. and more than 46-fold to 112. widespread disease requires chemotherapy or chemotherapy and/or monoclonal antibody therapy with radiation.2 percent for Hodgkin lymphoma in people under 20 years of age. groin or in the abdomen. the highest incidence of non-Hodgkin lymphoma is in Asian/Pacific islanders.9 percent). In children from 0 to 19 years of age.to 24year-old individuals. Incidence in Children The incidence of Hodgkin lymphoma among people under 20 years of age was 1. In the United States. Non-Hodgkin lymphoma is the ninth most common cause of cancer death in males and the seventh in females in the United States. It is rarest among American Indian/ Alaskan native children. comprising nearly 5 percent of all cancers diagnosed.070 from Hodgkin lymphoma). Deaths An estimated 19.4 cases per 100.400 children under the age of 15 will be diagnosed with cancer in 2007. Early stage. About 2.730 persons will die from lymphoma in the United States in 2007 (18. and non-Hodgkin lymphoma. persistent fatigue.1 cases per 100.1 cases per 100. about 10.5 percent. troublesome itching and weight loss. indigestion and abdominal pain. most children with nonHodgkin lymphoma did not live five years after diagnosis. Treatment for non-Hodgkin lymphoma sometimes includes vaccines and other forms of immunotherapy. cell type and location of the lymphoma. In children up to age 14 years. This represents a significant improvement in the rate of recovery. Death rates have been declining for Hodgkin lymphoma patients since the mid-1970s. localized non-Hodgkin lymphoma is sometimes treated with radiation. The incidence in this group decreased almost steadily and significantly between 1975 and 1999. excessive tiredness. From ages 15 to 19. Survival for Children Five-year relative survival is 95. and is the eighth most common cause of cancer death in that group. In children under 20 years of age.Among women.8 percent for all races in 1996-2003. 1. The rate increases more than 18 times to 45.5 percent) are the third most common cancers in children. Hodgkin lymphoma incidence rates are higher in adolescents and young adults than in adults in their middle years. chemotherapy or both may result in cures for most patients with Hodgkin lymphoma. 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. followed closely by Hispanic children of all races (24. Radiation. recurrent high fever. Incidence in Adults The incidence of non-Hodgkin lymphoma increases with age. night sweats. armpit. The five-year relative survival rate for non-Hodgkin lymphoma patients has risen from 31 percent in whites in 1960-1963 to 63. Even in the mid-1970s. loss of appetite and bone pain.0/1 million population).1 per 100. Symptoms also often include fever. Five-year relative survival is now 95 percent for Hodgkin lymphoma in children aged 0 to 14 years. five-year relative survival for non-Hodgkin lymphoma is now 83. LEUKEMIA LYMPHOMA MYELOMA page 11 .8 percent) and neoplasms of the brain and other nervous tissue (17. Signs and Symptoms Signs and symptoms of Hodgkin lymphoma include painless swelling of lymph nodes in the neck. Treatment Hodgkin lymphoma is often treated with radiation and chemotherapy.000 people occur in 20. armpit or groin. Non-Hodgkin lymphoma is the fifth most common cancer in Hispanics.000 by ages 60 to 64.5/1 million population).5 percent. following leukemia (26. 3. the highest incidence of non-Hodgkin lymphoma is in non-Hispanic whites.
Age-Specific Incidence Rates for Non-Hodgkin Lymphoma. 2000-2004 6 Incidence (per 100.8 2.370 Female 300 9.9 3.0 2.8 4. 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 2007.4 80.4 2.8 3.4 15.1 0. American Cancer Society.4 4.5 10.1 3.000) 70 60 50 40 30 22.660 19.0 20 10 0 0. 2000-2004 110 100 90 80 Incidence (per 100.5 <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.0 1.4 2.9 1.4 3.Age-Specific Incidence Rates for Hodgkin Lymphoma.1 102. National Cancer Institute. 2007. 2007.8 112. Epidemiology and End Results) Cancer Statistics Review 1975-2004. *<16 cases per time interval. Epidemiology and End Results) Cancer Statistics Review 1975-2004. National Cancer Institute. Epidemiology and End Results) Cancer Statistics Review 1975-2004. 2007. Table 6: Source: SEER (Surveillance.6 32.1 4.000) 5 4 3 2 1 0 0. * <16 cases for time interval.0 0.4 2.2 4.1 63.070 18.060 9.0 45.9 4.1 3.600 10. LEUKEMIA page 12 LYMPHOMA MYELOMA .0 100.9 7. 2007.730 Male 770 9.3 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 1.1 0.4 2.6 0.2 1.3 <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.0 3.
causing pain and crowding out normal blood cell production. Malignant plasma cells produce an abnormal protein called monoclonal immunoglobulin. approximately double.5/100. especially in the marrow. *<16 cases for each age interval.0 37. 15-19. Patients may have anemia. 2000-2004 Incidence (per 100. but it is the most difficult blood cancer to treat successfully.1 Signs and Symptoms Often the first symptom of myeloma is bone pain caused by the effects of myeloma cells in the marrow. Figure 9: Source: SEER (Surveillance. 20-24). • The median age at diagnosis is 70. Recurrent infections may be an early sign of the disease.000).1 5. 5-9. 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. the cell that forms plasma cells. At times. 10-14.1 28. Treatment may include intensive chemotherapy followed by stem cell transplantation to restore normal blood cell production. Total survival for white males.790 deaths from myeloma are anticipated this year. a type of white blood cell found in many tissues of the body. Deaths Approximately 10. Epidemiology and End Results) Cancer Statistics Review 1975-2004. a B lymphocyte. The mortality rate from myeloma for people of African descent is more than double the rate for whites (7.4 33. two or three drugs are used simultaneously. (11. Approximately 3 percent of all cancer-related deaths among AfricanAmericans in 2000-2004 were from myeloma. myeloma was the 10th most commonly diagnosed cancer among African-American men and women. Sixty percent of those were diagnosed with the disease within the past four years. SEER 17 areas (<1. and it rarely occurs in people under age 45. Living with Myeloma An estimated 60. tire more easily and feel weak.5 3. Treatment Chemotherapy for myeloma has led to sustained remissions in some patients. 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.1 21.1/100.000) 40 30 20 10 0 0-24 0.3/100. It grows continuously and forms masses of plasma cells. National Cancer Institute. Treatment is aimed at slowing progress of the disease.4 35. especially. Thalidomide is approved by the FDA for use in treating newly diagnosed myeloma. destroying normal bone tissue. • The median age at diagnosis for African-Americans is 67.S.000).8 14.900 (10.2/100. The onset of myeloma interferes with normal production of antibodies and makes myeloma patients susceptible to infections. 2007.5/100. It is 71 for African-Americans. Myeloma was the 10th most common cause of cancer deaths for women in 2000-2004. New Cases An estimated 19.000 to 3. The U. From 2000 to 2004. Usually. Lenalidomide is approved by the FDA in combination with dexamethasone for the treatment of myeloma patients who have received at least one prior therapy.960 men and 8.3 0.7 1. • Americans of African descent have a much higher incidence rate.940 women) new cases of myeloma will be diagnosed in the United States in 2007. LEUKEMIA LYMPHOMA MYELOMA page 13 . 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.Myeloma Myeloma is a cancer of the plasma cells. The highest rates are found in black men 80 to 84 years of age and older (105/100. but primarily in the bone marrow. • The incidence rate in men (7/100. In myeloma. the patient’s own stem cells are used (autologous stem cell infusion). median age at death from multiple myeloma is 74.424 people in the United States are living with myeloma. Fractures may occur as a result of the weakened bones. Bortezomib has been approved for treating myeloma in patients who have had at least two prior therapies. becomes malignant.9 9. 1-4.1 0.000) for all racial and ethnic groups.000) is 56 percent higher than for women (4. has been increasing.000) of myeloma than those of European descent (5.000). Age-Specific Incidence Rates for Myeloma.
per 100. for Whites.2 Male 16.9 17.3 19.6 Male 16. Epidemiology and End Results) Cancer Statistics Review 1975-2004.0 23.2 2. Epidemiology and End Results) Cancer Statistics Review 1975-2004.5 Incidence Rates by Gender.3 2.7 24.1 11.) LEUKEMIA page 14 LYMPHOMA MYELOMA .000 Population (2000-2004) Type Leukemia Non-Hodgkin lymphoma Hodgkin lymphoma Myeloma Overall 12.5 Table 8: Source: SEER (Surveillance. per 100.0 2.1 3.2 14.6 2. per 100. National Cancer Institute. 2007.8 14.Incidence Rates: Leukemia. 2007.0 7. (Based on SEER 17 areas. Lymphoma and Myeloma The following tables showing incidence rates for leukemia.0 Female 8.000 Population (2000-2004) Type Leukemia Non-Hodgkin lymphoma Hodgkin lymphoma Myeloma Overall 12.000 population and are age-adjusted to the 2000 population.6 4.7 5.0 Female 9. All Races. National Cancer Institute. Rates are per 100.) Table 9: Source: SEER (Surveillance.1 2.4 11.6 Female 9.2 6.000 Population (2000-2004) Type Leukemia Non-Hodgkin lymphoma Hodgkin lymphoma Myeloma Overall 10. National Cancer Institute.1 Table 10: Source: SEER (Surveillance.2 18.9 5. 2007.1 9.3 2.) Incidence Rates by Gender.5 16.8 20. Epidemiology and End Results) Cancer Statistics Review 1975-2004. (Based on SEER 17 areas. Hodgkin and non-Hodgkin lymphoma and myeloma use figures from 2000-2004. the most recent available.9 2.3 Male 13.4 4.2 3. (Based on SEER 17 areas. for Blacks. Incidence Rates by Gender.
300 110 63.310 800 600 900 920 330 1.670 1.160 140 50 360 440 170 320 * 18. 2007.830 240 230 60 * 1. model (see below).680 920 340 890 170 290 330 190 1.180 4. *Estimate is fewer than 50 cases. Note: These estimates are offered as a rough guide and should be interpreted with caution.S.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. Numbers are rounded to the nearest 10. **State estimates may not add up to U.510 500 60 70 900 380 220 160 280 430 100 370 460 730 310 170 400 70 110 120 80 650 120 1.550 2. Table 12: Sources: Cancer Facts & Figures 2007.370 100 * 430 380 130 350 * 19.150 290 270 70 * 1. Note: These estimates are offered as a rough guide and should be interpreted with caution.520 310 3.390 1. by State.Estimated New Cases of Blood Cancers by Site. 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. 2007 State Leukemia Non-Hodgkin Lymphoma Myeloma Hodgkin Lymphoma*** Estimated Deaths from Blood Cancers by Site.170 480 1.040 70 44. Mortality Public Use Data Tapes.030 570 * 610 210 360 1.360 960 170 220 2. January/February 2007. CA A Cancer Journal for Clinicians. LEUKEMIA LYMPHOMA MYELOMA page 15 . 2007 State Leukemia Non-Hodgkin Lymphoma Myeloma Hodgkin Lymphoma Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. and additional data supplied by the American Cancer Society based on data from the U.140 60 260 80 410 1.240 170 550 130 800 3. They cannot be compared with previous years’ estimates to determine cancer incidence trends.880 240 250 50 50 1. numbers are small and NCI and ACS are having difficulty fitting them into the Pickle et al. total because of rounding and exclusion of estimates that are fewer than 50 cases.260 220 400 420 290 2. Used with permission.540 1.S. which is new for 2007.370 250 280 2.200 350 4.030 910 620 420 680 680 250 630 1.130 300 80 900 960 300 1. 2006.710 570 500 2.190 880 870 170 100 4. 2007.160 1. is described by Pickle et al.410 560 * 740 230 230 930 70 300 50 350 1.190 290 * 280 200 1.010 1.080 600 7. The method of derivation. total because of rounding and exclusion of estimates that are fewer than 50 cases. American Cancer Society.790 330 * 320 200 1. American Cancer Society. 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 2.080 1.550 * * * * *20 * * * * 60 * * * 50 * * * * * * * * * * * * * * * * * * 70 * * 50 * * 60 * * * * 80 * * * * * * * 390 Table 11: Sources: Cancer Facts & Figures 2007.410 130 50 500 490 130 490 * 21.610 150 2.S.330 260 780 180 1.070 110 1.360 610 * 950 290 260 1. 1969-2004.240 740 80 1. Numbers are rounded to the nearest 10.070 80 330 70 480 1.560 770 890 3.530 1.500 430 1. ***Hodgkin lymphoma estimates are not available for 2007.070 Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist.610 670 610 110 60 3. Centers for Disease Control and Prevention.250 1. 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.. *Estimate is fewer than 50 cases.660 210 * 190 120 1. and additional data supplied by the American Cancer Society. **State estimates may not add up to U. National Center for Health Statistics. by State.140 380 140 1.630 540 80 120 990 510 310 230 320 330 100 390 490 770 400 210 460 80 150 160 100 680 120 1.
estimates of cancer incidence. The description of the methods used was published in Pickle et al.S. no matter how long ago that diagnosis was. may be incomplete in some cases and the data may reflect adjustments that anticipate changes that will occur once the actual data are received. LEUKEMIA page 16 LYMPHOMA MYELOMA . the data presented in the 2007 SEER report placed online on April 15. 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. Incidence rates can be calculated based on a number of factors such as age. Census. mostly upward. It includes new (incidence) and preexisting cases and is a function of both past incidence and survival. Definitions Incidence is the number of newly diagnosed cases for a specific cancer or for all cancers combined during a specific time period. In this report. This year. Because of this change in method.” as per SEER table I-21. Thus. Thus.) Prevalence is the estimated number of people alive on a certain date in a population who previously had a diagnosis of the disease. In some prevalence statistics. survival and mortality have been revised. The relative survival rate is a comparison of survival to a person who is free of the disease.S. The data presented in this report are an extrapolation or estimate of the number of cases reported by the 17 Surveillance. so the exact number of cases is not known. in some cases fewer than 17 SEER regions) and death data from the National Center for Health Statistics. Epidemiology and End Results Program (SEER) regions (or. it is the number of new cases per standard unit of population during the time period.S. Because of changes in the information — such as racial classification — gathered in the 2000 U. 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. cancer or otherwise. the American Cancer Society changed its method of estimating cancer incidence. if a person is initially diagnosed with melanoma and later develops leukemia. in comparison to the 2002 SEER report. only the first diagnosed cancer counts. This change means that the 2007 incidence estimates are not comparable with previous estimates for determining cancer incidence trends. population) that belong to the National Program of Cancer Registries. Bureau of the Census’ 2000 population data for that region. state-by-state data for incidence of Hodgkin lymphoma are not available because these numbers are so small. but these figures do not take into account differences in geography. especially in looking at populations in which individuals have had more than one type of cancer. Prevalence may be calculated in a number of different ways. his or her survival with leukemia may not be counted in leukemia prevalence statistics.. 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. Relative survival rate is an estimate of the percentage of patients who would be expected to survive the effects of the cancer. (Observed survival is the actual percentage of patients still alive at some specified time after diagnosis of cancer. based on the “first invasive tumor for each cancer site diagnosed during the previous 29 years (1975-2003). When expressed as a rate. It considers deaths from all causes. race and ethnicity in various regions and region-specific health risks. CA A Cancer Journal for Clinicians. 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. The SEER (17 region) data cover only about 26 percent of the U. 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. 2007. The specified date is 1/1/2004 for the prevalence estimates. Because of reporting delays from some of the SEER regions. January/February 2007. population. race or sex.S. 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. The data can be extrapolated for the entire United States by multiplying by the population ratio. prevalence numbers reported may vary depending upon the method used to determine them.Notes and Definitions Notes The United States does not have a nationwide reporting system or registry for blood cancers.” We are using the “29-year limited duration” prevalence figures.
“Lymphomas and Reticuloendothelial Neoplasms. 39-51. 065767. Bethesda. Epidemiology. Ries LAG (eds). pp. National Cancer Institute. National Cancer Institute. Mariotto A. Edwards BK (eds). 2007. 2007. Howlader N. Epidemiology. pp. Tiwari RC. Hao Y. Barr R. MD. Barr R.” Pickle LW.” Mattano L Jr. 2007. “Cancer Statistics. 065767. Ross J. January. SEER (Surveillance. January/February. Cheson B. Keller F. 2006. Feuer EJ. “Leukemias. Barr R.cancer. http://seer. Bethesda. 25-38. NIH Pub. 1975-2004. Including SEER Incidence and Survival: 1975-2000. Ries LAG (eds). Ward E.org/cgi/content/full/57/1/30. Including SEER Incidence and Survival: 1975-2000. In Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age. Hachey M. MD. Trends. Bleyer A. Cancer Facts & Figures for African Americans 2007-2008. No. 12. Eisner MP. based on November 2006 SEER data submission. p. 174. 06-5767. In Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age. National Cancer Institute. http://www.amcancersoc. MD. O’Leary M. pp. O’Leary M. Including SEER Incidence and Survival: 1975-2000. http://caonline. Melbert D. MD. Bleyer A. and End Results (SEER) Program. Krapcho M. Howe HL. Reichman M. “A New Method of Estimating United States and State-Level Cancer Incidence Counts for the Current Calendar Year. No. Nachman J. NIH Pub. O’Leary M.Citations Source Citations Cancer Facts & Figures 2007. 30-42. Ries LAG (eds). Feuer EJ. NIH Pub. Clegg L. Atlanta: American Cancer Society. Shu X-O. and Multiple Primary Cancer Analyses from the Surveillance. National Cancer Institute. Barr R. Jemal A. Ries LAG. Bethesda. posted to the SEER Web site 2007.com/cgi/content/full/12/1/20. Atlanta: American Cancer Society. Howlander N.” Bleyer A. Bethesda. The Oncologist Vol. 2006. 2006. Edwards BK. 57.gov/csr/1975_2004/ LEUKEMIA LYMPHOMA MYELOMA page 17 . 20-37.” Hayat MJ. pp.” O’Leary M. and End Results) Cancer Statistics Review. Reichman ME. No. Bleyer A. “Highlights and Challenges. Zou Z. In Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age. 2007.TheOncologist. Stock W. CA A Cancer Journal for Clinicians Vol. Sheaffer J. Miller BA. Horner MJ.
lymphoma and myeloma.000 over three years.000 over three years.25 million.000 a year for a total of $180. Hodgkin’s disease and myeloma.000 over three years. research reaching a clinical trial can receive $1 million over five years to facilitate new drug discovery or advances in diagnosis or prevention. the Society has awarded more than $550 million in research grants.6 million annually on research. Research grants are awarded in three program areas: Career Development. 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 . Translational Research Program The Translational Research Program provides early-stage support for research on leukemia. Awards go to those groups that best demonstrate the synergy that will occur from their close interaction. treatment or prevention of leukemia. 2) CDP-clinical research. The program is expected to generate new knowledge and breakthrough discoveries. Each SCOR is funded up to $1. They are: 1) Career Development Program (CDP)-basic research. Funding for two additional years may be provided for highly promising projects that are entering phase I clinical trial. lymphoma or myeloma. leading to better survival rates and prevention measures for patients.25 million per year over a five-year period. The Society is a nonprofit organization that relies on the generosity of individual and corporate contributions to advance its mission.000 a year for a total of $180.000.000 a year for a total of $150. • Special Fellows in Clinical Research are awarded $60. Translational Research and the Specialized Center of Research (SCOR). for a total of $600. 3) Translational Research Program. Research Research Grant Programs The Society’s research programs are based on the belief that all scientifically sound approaches toward a cure for. lymphoma. • Special Fellows are awarded $60. Awards up to $200. 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. Since the first funding in 1954. the Society’s grant programs are among the most prestigious in the fields of blood cancers. to a total cost of $6.000 per year for three years. lymphoma and myeloma should be encouraged worldwide.000 a year for a total of $550.000 a year for a total of $550. The SCOR grants also support scientific core laboratories to provide access to innovative technology if required by the participating research programs. lymphoma and myeloma research comprise four review subcomittees. each focused on the discovery of new approaches to benefit patients or those at risk for developing leukemia.000 over five years. are granted each year. The participating scientists may be at different institutions or from any country. Career Development Program The Career Development Program supports promising young scientists (Scholars. Translational Research • Scholars in Clinical Research are awarded $110. The Grant Review Process Scientists and physician-scientists who are experts in the field of leukemia. and improve the quality of life of patients and their families. Translational Research Awards are made for an initial three-year period. The SCOR program brings together research teams working in complementary areas. lymphoma and myeloma that is intended to advance treatment. Now supporting $61.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. leukemia. diagnosis or prevention in the near term. Thus. The Specialized Center of Research (SCOR) in Leukemia. or control of.000 over five years. We offer a wide variety of programs and services in support of our mission: Cure leukemia. • Fellows are awarded $50.
m. Each year. Information on registration for these free events can be accessed at www. It is continually being updated and expanded to support and promote the Society’s mission. The Annual Research Symposium.org or by or emailing researchprograms@LLS. information about our peer-to-peer program First Connection and other programs. They are available to talk one-onone. audio.org. Information specialists are oncology social workers and health educators who provide callers with current information on blood cancers. www. Guidelines. The user has the opportunity to create personalized pages with identified interests. each group provides information and support. clinical trials and offer guidance on coping. A trained patient volunteer currently in remission phones the new patient to share information and support. Monday through Friday. Teleconferences and Webcasts The Society sponsors more than 25 educational teleconferences and Webcasts each year on topics of interest to patients and caregivers. Educational Materials An extensive collection of free educational materials are offered to patients and health professionals. brochures and videos through the IRC and local Society chapters.important projects to advance the Society’s mission.org or faxing to (914) 949-6691 or contacting the Research Department at (914) 949-5213.LLS. The Society’s Web Site The Society’s Web site. Professional Education The Society serves the continuing educational needs of the medical and research community through professional symposia offered throughout the year. These include the Stohlman Scholar Symposium. and applications for the Society’s three research programs may be obtained by visiting www.LLS. friends and healthcare professionals. the Translational Research Grant Progress Review Meeting and the SCOR Progress Review Meeting. their families and healthcare professionals. myelodysplastic syndromes (MDS) and other blood cancers.m. myeloma. families and professionals may call the IRC toll free at (800) 955-4572 in addition to corresponding by email at infocenter@LLS. to 6 p. As of June 30. Family Support Group locations.LLS.org. sponsored by the Society. First Connection: This program links newly diagnosed patients to a peer volunteer who has experienced a similar diagnosis.LLS. and encourages greater communication among patients.org. Co-Pay Assistance Program Patients with AML. Information Resource Center (IRC) The Society strives to be the world’s foremost source of information on leukemia.org. Patients needing assistance may apply on the Society’s Web site. is held each December on the Friday immediately before the American Society of Hematology meeting. families. The IRC is a worldwide link to information and resources useful to patients. 9 a.m. peer counseling and patient financial aid. The educational program offers varying formats to facilitate the exchange of information and ideas on the newest developments in cancer research and treatment. ET. call (877) LLS-COPAY ( 557-2672) or email copay@LLS. Guided by two volunteer oncology health professionals. the Society’s programs and services. and click “Live Help. This support should advance the understanding. The Society also hosts numerous teleconferences and Webcasts. serves a wide variety of education and information needs. lymphoma. lymphoma.org/copay. from 10:00 a. lymphoma and myeloma. to 5:00 p. where medical professionals share the latest research findings. treatment and prevention of leukemia. www. podcasts and Webcast archives of these programs are available at www. including support groups. Patient Services The Society has a network of 68 chapters throughout the United States and Canada. These offices conduct lifeenhancing patient services. You may also chat online with an information specialist. www. instructions. 2007 the Society will have 379 active grantees at 116 institutions in the United States and abroad.LLS.org. The Society funds several Focused Workshops each year on important topics relevant to hematological malignancies. Patients.org. 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.org.m. the Society distributes more than 1 million booklets.” Chapter Programs: Family Support Groups: The Society has developed more than 360 Family Support Groups at 68 chapters. Much of the content of these materials is available to view and download at www. The site features a comprehensive overview of blood cancers. ET. on the Society’s Web site. treatments. Other meetings are held for the Society’s grantees.LLS. LEUKEMIA LYMPHOMA MYELOMA page 19 .LLS.
and offers numerous resources that can assist childhood cancer survivors to flourish in the school environment posttreatment. representing to policy makers at all levels of government the healthcare quality concerns and medical research interests of patients and their families. videos and other materials to aid the process are available through all local chapters. treatments. It is supported by Amgen Oncology. CML Issues and Insights: A Nursing Education Program on Chronic Myelogenous Leukemia. treatments. risk factors. Welcome Back: Facilitating the Return to School for Children with Cancer: A new addition to The Trish Greene Back to School Program. Advocacy Since 1994. staging and classification of nonHodgkin lymphoma (NHL). Patient financial aid funds are subject to availability. To date. Department of Defense’s medical research program. the Society successfully lobbied Congress to institute a blood cancer research initiative as part of the U.LLS. This program is made possible by the Lance Armstrong Foundation. Through the Patient Financial Aid Program.and long-term effects that children may experience after treatment. In 2001. the Society’s advocacy program has been a strong voice in Washington. That network now numbers more than 35. In 2002. Printed literature. lymphoma and myeloma. emerging therapies and side effects and addresses the unique challenges of nursing management of these patients. LEUKEMIA page 20 LYMPHOMA MYELOMA . parents. treatments and future directions for NHL are also discussed. this education program discusses possible emotional and cognitive short. 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.S. 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. 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. the Society has helped patients demonstrating a need for financial assistance cover a portion of their treatment costs. New insights. This program is being sponsored by an unrestricted education grant from Novartis Oncology. The Trish Greene Back to School Program for Children with Cancer: This program is designed to increase communication among healthcare professionals. emerging therapies and managing side effects and how to find emotional support when living with the illness. diagnosis. reimbursement of up to $500 per year helps cover the costs of transportation. Society volunteers and staff visit Capitol Hill regularly to lobby Congress in support of issues that impact research and patient care. This Society program is being supported by Celgene Corporation and Millennium Pharmaceuticals.org and is being sponsored by a generous. 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. Working through chapters across the country. how cancer drugs are developed and what the emerging treatment options are for leukemia. On the state level. Meet the Expert on Non-Hodgkin Lymphoma: This program presents basic information on terminology. patients and school personnel to assure youngsters a smooth transition from active treatment back to school.Patient Financial Aid Program: For more than 31 years. that program has funded some $30 million in additional blood cancer research.000 and has become a potent voice in public policy deliberations. This nursing education program provides an overview of CML. families and healthcare professionals with a clear description of what clinical trials are. This program is provided through an unrestricted educational grant from Millennium Pharmaceuticals. drugs and various treatments not covered by insurance. The patient education program was funded at $18 million through 2007. DC. The Path to Progress: Clinical Trials in Blood Cancers: This program provides patients. The Society has identified key issues that currently shape its advocacy agenda. providing additional support for blood cancer patients and their families nationwide. New Directions in Myeloma Therapy: This program presents an overview of myeloma. 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. This program is also accessible as a Webcast at www. unrestricted educational grant from Genentech BioOncology and Biogen Idec Inc.
provided statistical assistance.D. provided ACS’s state-by-state statistics on myeloma and Hodgkin lymphoma. for compilation of data for this publication. and Rebecca Siegel.Acknowledgements Additional data from SEER*Stat Databases at http://www. This publication is designed to provide information in regard to the subject matter covered.seer.cancer. Milton Eisner of SEER. It is distributed as a public service by The Leukemia & Lymphoma Society Inc. of the American Cancer Society (ACS). Ph. NCI.gov.. The Leukemia & Lymphoma Society extends special thanks to Myrna Watanabe. with the understanding that the Society is not engaged in rendering medical or other professional services. .
955.4572 www. corporate and foundation contributions to advance its mission. and improve the quality of life of patients and their families. PS80 35M 6/07 .LLS.Home Office 1311 Mamaroneck Avenue. lymphoma. New York 10605 Tel: 888. The Society is a nonprofit organization that relies on the generosity of individual.org Our mission: Cure leukemia.HELP. Suite 310 White Plains. Hodgkin’s disease and myeloma.LLS Information Resource Center (IRC): 800.
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