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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.
380 new cases of lymphoma will be diagnosed in the United States (8. • Eighty-six percent of myeloma cases occur in people aged 55 and over. *Myeloma Biology and Management. • In general.920 new cancer cases diagnosed in the United States this year. is a compilation of the most recent data on leukemia. or nearly six people every hour. Cancer Statistics Review 1975-2004 (see Notes. which becomes malignant and multiplies continuously.953 either have or are in remission from non-Hodgkin lymphoma (NHL). in April 2007. and myeloma. 44. 2007 and SEER 19731993.266 people living today with lymphoma. 63. Hodgkin and non-Hodgkin lymphoma. More males are diagnosed with leukemia and more males die of it than females.240 people will be diagnosed with leukemia.444. 21. 1960-1963 1975-1977 1996-2003 Figure 1: Sources: SEER (Surveillance. 405.349 Americans are living with leukemia. nonacute myelogenous and monocytic leukemias Lymphoma: • There are 544.070 from Hodgkin. The data within Facts 2007-2008 reflect the most recent statistics available from SEER. 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. *except acute myelogenous leukemia (AML) and other. From 1975 to 2004. 1975-2004. the National Cancer Institute’s Surveillance. lymphoma and myeloma. Leukemia.1975-1977 vs. someone dies from a blood cancer. an annual publication.190 cases of Hodgkin. • Every 10 minutes. 138. • In 2007. National Cancer Institute. Mortality from the disease increased 24 percent. someone is diagnosed with a blood cancer. Five-Year Relative Survival Rates 1960-1963 vs. www. lymphoma and myeloma will cause the deaths of an estimated 52. 2nd Edition.424 people living today with myeloma. This year.190 cases of non-Hodgkin). Myeloma: • • • • There are 60.3 percent of the deaths from cancer in 2007 based on the 559. 18. The next SEER Cancer Statistics Review is expected to be published online in April 2008. Epidemiology and End Results) Cancer Statistics Review. 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. lymphoma and myeloma decreased from 1995 to 2004 (the last year data were available).310 people in the United States this year.650 total cancer-related deaths. Highlights from the Report Include: New Cases • An estimated 135.659 people in the United States who are either living with or are in remission from leukemia. This year. This statistic represents 143 people each day. 19. This abnormal accumulation interferes with the production of healthy blood cells. 1998.790 people will die from myeloma.660 from non-Hodgkin).Executive Summary Facts 2007-2008.520 people in the United States will be diagnosed with leukemia.seer. 71. the likelihood of dying from most leukemias*. • This year.790 people will die of leukemia.gov. • In 2007.4 percent of the 1. Deaths • Leukemia. Epidemiology and End Results Program. page 16). • Thirty-two percent more males are living with leukemia than females. Survival • An estimated 823. • Non-Hodgkin lymphoma is the fifth most common cancer in the United States. • New cases of leukemia. Hodgkin and non-Hodgkin lymphoma and myeloma will account for nearly 9. Oxford University Press.900 people will be diagnosed with myeloma. • This year. lymphoma and myeloma in 2007.cancer. National Cancer Institute.730 people will die from lymphoma (1. • Every five minutes. the incidence of myeloma increased 8 percent. 10. • Leukemia causes more deaths than any other cancer among children and young adults under the age of 20. and its age-adjusted incidence rose by nearly 84 percent from 1975 to 2004. LEUKEMIA LYMPHOMA MYELOMA page 1 . 19. 1996. These data were published online by SEER. • These blood cancers will account for 9.313 either have or are in remission from Hodgkin lymphoma.
slightly mismatched cord stem cell donors may be used quite successfully. some types of Hodgkin lymphoma. They are considered to be related cancers because they arise from cells with a common origin (the lymphohematopoietic stem cells) and with related functions. Syngeneic transplant describes the use of an identical twin as donor. Such an approach would greatly lessen the proportion of children without a 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. Patients with acute lymphocytic leukemia (ALL). The technique is important. The harvesting. 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. which becomes abnormal (malignant) and multiplies continuously. 2007. The technique of harvesting stem cells from blood and cord blood has made transplantation available for more LEUKEMIA page 2 LYMPHOMA MYELOMA . If a sibling is not available. The accumulation of malignant cells interferes with the body’s production of normal blood or immune cells and can result in severe anemia. studies suggest that two matched cord donors may result in a higher success rate in larger adults. 2007. Hodgkin and non-Hodgkin lymphoma and myeloma are cancers that originate in a cell in the bone marrow or lymphatic tissues. Estimated New Cases (%) of Blood Cancers in 2007 Myeloma 15% Leukemia 33% Lymphoma 53% Treatment Chemotherapy and Radiotherapy: The use of chemotherapy (anticancer drugs). myeloma and lymphoma are usually treated with chemotherapy. especially in young children. 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.About the Diseases Leukemia. is largely responsible for the dramatic improvement in managing leukemia and lymphoma. These diseases usually result from an acquired genetic injury to the DNA of a single cell. 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. The numbers of stem cells in cord blood are often insufficient for the needs Figure 2: Source: Cancer Facts & Figures. An allogeneic transplant uses blood or marrow stem cells from a normal donor. Patients with leukemia. decreased ability to fight infections and a predisposition to bleeding. especially for children. for which a parent rather than a sibling could be the donor. There are two major types of stem cell transplants: syngeneic and allogeneic. Approximately 50 different drugs are now being used in the treatment of these diseases. 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. (Numbers do not add up to 100% because of rounding. Research is being conducted to improve socalled “haploidentical” transplant. usually in combinations of two or more drugs. In special instances. Autologous transplantation uses the patient’s own marrow stem cells and is technically not transplantation since another person is not the donor. However. Stem cells also circulate in large numbers in fetal blood and can be recovered from umbilical cord and placental blood after childbirth. The blood or marrow stem cells are collected while the patient is in remission. lymphoma and myeloma.) of larger adult patients. American Cancer Society. 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.
or genetic factors that can increase susceptibility to certain effects. Imatinib mesylate (Gleevec®) is now the drug of choice in newly diagnosed patients with chronic myelogenous leukemia (CML). Development of New Drugs: In the past decade. Stem cells not only reside in the marrow but also circulate in the blood.org/). lymphoma or myeloma is attacked and suppressed by donor lymphocytes that form from the donor stem cells. the donor’s cells take hold and the patient’s leukemia. few severe adverse effects on normal tissues and a very high response rate. but some follow adult cancer survivors. “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. Identifying these biomarkers will allow researchers to develop tests that can predict what effects an individual is at risk of developing. is a source of stem cells for transplantation. New Approaches to Treatment Several areas of research have resulted in new approaches to the treatment of leukemia. Cancer survivors should see their primary care physicians for general health examinations and an oncologist for follow-up care related to cancer. Blood and cord blood transplants differ from marrow transplants principally in the source of the cells collected for transplant. Regular examinations may include screening for cancer recurrence or the development of secondary cancer or other late effects of treatment. making the procedure more tolerable. lymphoma or myeloma and permit the donor’s cells to be accepted by the temporarily immunodeficient recipient. decreased side effects. as well as marrow. lymphoma or myeloma can have an allogeneic transplant. Follow-Up Care Regular medical follow-up enables doctors to assess the full effect of therapy. Some treatment centers have follow-up clinics that provide a comprehensive. This still experimental approach greatly lessens the early toxicity of transplantation and has extended the age at which recipients with leukemia. 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. The protein is an enzyme in the family of tyrosine kinases. marrow and immune system. two second-generation agents. 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. and Young Adult LEUKEMIA LYMPHOMA MYELOMA page 3 . Follow-Up Guidelines: The Children’s Oncology Group has established Long-Term Follow-Up Guidelines for Survivors of Childhood. In nonablative transplantation. Although a minority of patients have developed resistance to the drug. Because blood. Most follow-up clinics specialize in pediatric cancer survivors. the recipient’s blood cell and immune system are preserved. these cells can be harvested from the blood of a donor. Coordination between specialists and primary care physicians is essential to provide the best care possible. ablation of the recipient’s blood-cell forming and immune cells was the price that had to be paid to eradicate the leukemia. “Ablation” referred to wipingout the recipient’s cancer. 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. In standard stem cell transplantation. lymphoma and myeloma. as needed. This “graft versus leukemia or lymphoma effect” can suppress (cure) the malignancy and is a prolonged (indefinite) form of immunotherapy.childrensoncologygroup. identify recurrence of the disease and detect long-term or late effects. It works by blocking the oncogeneencoded protein product that instigates the transformation to a leukemic cell. Over time. 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. Cancers (http://www. multi-disciplinary approach to monitoring and supporting cancer survivors. several important new drugs and new uses for existing drugs have greatly improved cure rates or remission duration for some patients with leukemia. Biomarkers could be high levels of certain substances in the body such as antibodies or hormones. Adolescent. To ensure there will be enough blood stem cells for successful transplantation. donors of blood stem cells require special treatment to mobilize sufficient stem cells from marrow into their blood before cells are harvested. frozen and stored and later transplanted in the patient. Cancer survivors should have physical examinations yearly or more often. Gleevec offers several dramatic advantages to patients: oral administration.patients. thereby allowing doctors to plan treatment accordingly.
In May 2006. Clofarabine (Clolar®). reducing the need for transfusions in some patients. 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. PDGFR or KIT oncoproteins). Cladribine induces long-term remissions in nearly 90 percent of patients treated at diagnosis for one week. immune cell administration and vaccine development. lymphoma or myeloma. and enhances the specificity of treatment to minimize toxic effects on normal tissues. It is especially active against the lymphocytes in CLL. Monoclonal antibodies have added to the arsenal of agents that are used for the treatment of patients with lymphoma and leukemia. Cell surface antigens have been given a cluster designation (CD) followed by a number. Rituximab is an antibody directed at the target CD20 antigen on B-cell lymphoma cells. 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 less common type of chronic lymphocytic leukemia (CLL). principally. it has now become an important fifth drug in the R-CHOP–rituximab. farnesyl transferase inhibitors and reduced-intensity stem cell transplantation.dasatinib (Sprycel®)(approved by the U. Gleevec is not only a very important new agent in the treatment of CML. has improved dramatically with the introduction of cladribine. such as follicular lymphoma. LEUKEMIA page 4 LYMPHOMA MYELOMA . approved by the FDA in 2005. Early studies indicate the combination of arsenic trioxide and all-trans retinoic acid may be a further advance in the initiation of therapy. Monoclonal Antibody Therapy: Monoclonal antibodies are laboratory-produced proteins that can be infused into an appropriate patient. cyclophosphamide. are entering clinical use and can overcome this resistance in some cases. perhaps 20 percent of cases also derive benefit. In patients with anemia. but without this specific chromosome 5 abnormality. 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. however. and Decitabine (Dacogen®). but it can also induce remissions in some cases of acute leukemia. approved by the FDA for all types of MDS. symptomatic anemia have improvement in hemoglobin levels with this agent. Lenalidomide (Revlimid®). suppresses the progression of leukemia. thalidomide (Thalomid®). in combination with dexamethasone. 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.S. 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. Rituximab has become an important agent to treat CD20-positive lymphocytic malignancies. Velcade is approved by the FDA for treating people with myeloma who have had at least one prior therapy. Patients with more severe forms of MDS are very unlikely to respond to the agent. kill unhealthy bone marrow cells and may help the bone marrow function more normally in MDS patients. Indeed. Arsenic trioxide also adds to the drugs available to treat this subtype 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). Food and Drug Administration [FDA] in 2006) and nilotinib (in clinical trials). thus rituximab is an anti-CD20 antibody. doxorubicin (Adriamycin®). Other therapies in clinical research to treat MDS include arsenic trixoxide. Alemtuzumab (Campath®) is a monoclonal antibody directed against the antigen CD52 found on T and B lymphocytes. Some patients with moderately severe. Three types of immunotherapy are being explored: antibody treatment. the most prevalent lymphoma subtype. This drug is also being tested in clinical trials to treat adult acute leukemia and MDS. was approved by the FDA for newly diagnosed myeloma. Immunotherapy: This is a treatment that uses immune cells or antibodies to fight the disease. Pentostatin is another effective drug that can be used in patients with hairy cell leukemia who do not respond to cladribine. Azacitidine (Vidaza®). The treatment of hairy cell leukemia. 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®). is being used to treat relapsed or refractory acute lymphocytic leukemia (ALL) in children who have received at least two prior therapies. a thalidomide derivative. vincristine (Oncovin®) and prednisone–therapy for diffuse large B-cell lymphoma. although initially used in indolent lymphomas. chronic eosinophilic leukemia (formerly hypereosinophilic syndrome).
The goal of several new agents being studied is to decrease resistance to an important chemotherapy drug used in leukemia. If the gene in the former case is an oncogene or the protein in the latter case is an oncoprotein. cells are isolated in the laboratory and start making antibodies after insertion of the cancer antigen. 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. Paradoxically. Vaccines are in clinical trials for types of acute and chronic leukemia. 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. b) a modality that uses molecules of RNA to silence complementary (DNA) genes. These cells are. Vaccines: Experimental treatment vaccines are now being studied to treat certain types of lymphoma. These types of vaccines would be used in patients who have small amounts of residual blood cancer after chemotherapy or stem cell transplantation. In some approaches. Studies of vaccines used in patients with follicular or indolent lymphoma have demonstrated an immune response. In another approach. 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. Examples of this treatment are the drugs ibritumomab (Zevalin®) and tositumomab and iodine I131 tositumomab (Bexxar®). gemtuzumab (Mylotarg®). These are called conjugated monoclonal antibodies. In one approach. and aptamer treatment. Many cancer treatment vaccines under development are intended to induce antigen-specific antitumor immune responses. drugs are designed to interfere with the oncoprotein and prevent its effect on the cell. These drugs have been approved to treat relapsed B-cell non-Hodgkin lymphoma. In studies of CML. lymphoma and myeloma. They deliver the toxic substance directly to the cancer cells. or become. Patients with myeloma have also had remission re-induced by donor lymphocytes. is approved for older patients with AML who relapse after initial treatment. 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. the patient’s immune cells would be treated in the laboratory to train them to attack the residual leukemia. myeloma and leukemia. Monoclonal antibodies can also be linked to a radioactive isotope to target and kill specific cancer cells. This drug. This means that the vaccine induces an immune response against the cancer cells present in the patient. the infusion of the original marrow donor’s lymphocytes can re-induce remission. 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. 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. lymphoma or myeloma cells. DNA vaccines that contain the DNA that encodes the specific antigen are being tested. Reversal of Multidrug Resistance: The malignant cells of patients have mechanisms that may allow them to escape the damaging effects of chemotherapy agents. An alternative strategy called molecular targeted drug development targets the oncoprotein.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. LEUKEMIA LYMPHOMA MYELOMA page 5 . Two new and potentially important approaches include a) the application of RNA interference. some vaccines are made from leukemic cells treated in test tubes to convert them to potent antigen-presenting 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. The goal is to extend the duration of remission achieved by remissioninduction therapy of various types. gene therapy researchers are trying to modify an oncogene (BCR-ABL) that produces a protein that stimulates malignant cell growth. new forms of cancer therapy may be developed. less responsive to therapy. 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.
340 13.570 5.790). Chronic leukemias account for 7 percent more of the cases than acute leukemias. The terms myelogenous or lymphocytic denote the cell type involved.) • The most common types of leukemia in adults are acute myelogenous leukemia (AML) and chronic lymphocytic leukemia (CLL). Table 3: Source: Cancer Facts & Figures 2007. Epidemiology.240 Male 3. Only 2.240 new cases of leukemia will be diagnosed in the United States this year. • Most cases of leukemia occur in older adults.150 24. Prevalence of the Four Major Leukemias as of Jan. *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 divided into four categories: myelogenous or lymphocytic.S. based on the November 2006 SEER data submission. aged 0-19. red blood cells and white blood cells.659 people in the United States are living with leukemia.501 50.4 percent of leukemias in children aged 0-19 are CML. males are expected to account for 56 percent of the new cases of leukemia.000 2. (About 40. The four major types of leukemia are shown in Table 1.440 adults compared with 3. Anemia.S. develops in virtually all leukemia patients.960 7. New Cases An estimated 44. Chronic leukemia progresses more slowly and allows greater numbers of more mature.140 6. more than half of all cases occur after age 67. 2007. A shortage of platelets results in bruising and easy bleeding. and End Results) Cancer Statistics Review 1975-2004.440 Table 2: Sources: SEER (Surveillance.410 4. Surveillance Research Program. National Cancer Institute.800 Female 2.200 15. • About 33 percent of cancers in children aged 0-14 years are leukemia • Most cases of chronic myelogenous leukemia (CML) occur in adults. American Cancer Society.189 27. NCI. The lack of normal white cells impairs the body’s ability to fight infections. In 2007. released April 2007.Leukemia Leukemia is a malignant disease (cancer) of the bone marrow and blood. DCCPS.060 8.570 19.720 44. functionless cells in the marrow and blood.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. each of which can be acute or chronic. 1.579 21.350 2.570 3. Incidence by Gender Incidence rates* for all types of leukemia are higher among males than among females. *Note: Incidence rates are the number of new cases in a given year not counting the preexisting cases.000 population. The incidence rates are usually presented as a specific number per 100. and SEER Program.800 children. Acute leukemia is a rapidly progressing disease that results in the accumulation of immature.380 6. functional cells to be made. a deficiency of red cells. The marrow often no longer produces enough normal platelets. 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. • The most common form of leukemia in children is acute lymphocytic leukemia (ALL). 2007. 2004 Type Chronic lymphocytic leukemia Chronic myelogenous leukemia Acute lymphocytic leukemia Acute myelogenous leukemia Prevalence* 95.060 2. LEUKEMIA page 6 LYMPHOMA MYELOMA . Estimated 29-Year L-D Prevalence Counts on 1/1/2004 by Duration. It is characterized by the uncontrolled accumulation of blood cells. Statistical Research and Applications Branch. Leukemia is expected to strike more than 10 times as many adults as children in 2007. Prevalence database: U. Approximate U. Nearly 54 percent of the new cases of this disease will occur among children in 2007 (about 2.
In 25. neither explains most cases. CLL incidence increases dramatically among people who are aged 50 and older. leukemia rates are higher in Americans of European descent than among those of African descent. They do warrant medical evaluation.000 population. including the examination of the cells in blood or marrow. 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.5 times that of ALL. there were 4. From 1975 to 2000. was 504 per 100. The cause of leukemia is not known.799 children under the age of 20 diagnosed with leukemia from 2001-2004. Leukemia is one of the top 15 most frequently occurring cancers in minority groups. Leukemia strikes all ages and both sexes. These signs are not specific to leukemia and may be caused by other disorders. The diagnosis of leukemia requires specific blood tests. About 2. However. American Indian/Alaskan natives. LEUKEMIA LYMPHOMA MYELOMA page 7 . American Cancer Society. eighth and ninth decades of life. Adolescents and Young Adults.922 cases per year. ALL incidence was approximately twice that of AML. Adults.to 19-year olds.800 children will be diagnosed with leukemia throughout the United States. Figure 3: Source: Cancer Facts & Figures 2007. Leukemia incidence is highest among whites and lowest among American Indians/Alaskan natives. Some people with chronic leukemia may not have major symptoms and are diagnosed during a medical examination.to 4-year-old children is more than nine times greater than the rate for young adults ages 20 to 24. The most common form of leukemia among children under 20 years of age is ALL. It is estimated that in 2007.Estimated Proportion of New Cases (%) in 2007 for Each Type of Leukemia Including Adults and Children 3. AML incidence was approximately 1. 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. Incidence by Age-Group Incidence rates by age differ for each of the leukemias. In the 17 SEER regions of the United States. 2007. 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). The incidence of ALL among 1. white and Asian/Pacific islander children than for black children.900 new cases of cancer diagnosed in African-Americans in 2007.790 new cases of childhood ALL are expected to occur in 2007. from 2000-2004. Although chronic exposure to benzene in the workplace and exposure to extraordinary doses of irradiation can be causes of the disease. and AML incidence increases dramatically in people who are aged 60 and older. Children. Most children under 15 years of age with ALL are cured. including 3.619 with ALL. Leukemia rates are substantially higher for Hispanic. These cancers are most prevalent in the seventh. Among 15. CML incidence also increases dramatically among people who are aged 60 and older. averaging about 189. The incidence rate for all cancers among AfricanAmericans in the Seer (17 region). The leukemias represented 27 percent of all cancers occurring among children younger than 20 years from 2000-2004.to 29-year olds. Hispanic children of all races under the age of 20 have the highest rates of leukemia. Possible Causes of Leukemia Anyone can get leukemia. The American Cancer Society estimates that there will be approximately 152. the incidence of AML slowly rose while that of ALL steadily decreased in the period from late adolescence to older adulthood.
3 percent overall.4 5-9 0. 2007. 54.2 10. Treatment centers report increasing numbers of patients with leukemia who are in complete remission at least five years after diagnosis of their disease. when compared to a person without leukemia. the five-year relative survival rates overall were: • ALL: 65. 2000-2004 25 23. race and type of leukemia.2 15 13 11 9 7. During 1996-2003.9 15-19 0.1 4.9 20-24 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. gender. By 1975-1977. a complete remission (no evidence of disease in the blood or marrow) that lasts five years after treatment often indicates cure.4 percent Five-Year Relative Survival Rates for All Ages.5 21. and in 1996-2003.2 23 21 19 19.7 percent overall.9 25-29 1. The relative survival rates differ by age of the patient at diagnosis.1 for children under 15 • CML: 44. National Cancer Institute.3 3. Treatment of Leukemia The aim of treatment is to bring about a complete remission.6 10-14 0.8 1-4 0. Thirty-two percent more males than females are living with leukemia.1 Incidence (per 100. 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. Relapse indicates return of the cancer cells and the return of other signs and symptoms of the disease.000) 17 15.8 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. In 1960-1963.2 1. a patient had a 14 percent chance of living five years. All Types Leukemia.4 percent for children under 5 • CLL: 74. the five-year relative survival rate had jumped to 35 percent.3 1.8 percent • AML: 20. Epidemiology and End Results) Cancer Statistics Review 1975-2004. the overall relative survival rate was nearly 50 percent.6 2. 90. The five-year relative survival rate has more than tripled in the past 47 years for patients with leukemia. LEUKEMIA page 8 LYMPHOMA MYELOMA . 2007.Age-Specific Incidence Rates for Acute Myelogenous Leukemia (All Races). For acute leukemia. National Cancer Institute.7 7 5 3 1 0 1. Epidemiology and End Results) Cancer Statistics Review 1975-2004.4 <1 0. 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.
1964:24:477-494. In 2007. deaths from leukemia are expected to be distributed in the following numbers: In 2007.420 4. 2007. about 515 children under the age of 14 are expected to die from leukemia.990 deaths from AML and 490 deaths from CML. 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. In 2007. Non-Hispanic whites diagnosed with leukemia over the age of 44 had the highest death rates during this period. American Cancer Society. Hispanics with leukemia who are under the age of 25 had the highest mortality rates from the disease between 1990 and 1999. 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. 1975-2004. Deaths It is anticipated that approximately 21. There will be an estimated 4. Epidemiology and End Results).320 Female 600 1. Unclassified forms of leukemia will account for 6.420 deaths from ALL. 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. 2007.970 250 2.470 females.940 3. leukemia causes more deaths than any other cancer among children and young adults under age 20.500 8.680 12. Zuelzer WW. Sources: 1. Blood. unclassified forms of leukemia Total Overall 1.020 240 3.390 21.320 males and 9. 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.500 deaths from CLL and 1.Five-Year Relative Survival Rates for Acute Lymphocytic Leukemia.470 Table 4: Source: Cancer Facts & Figures 2007. in Children Under 15 Years of Age. 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.710 9.790 deaths in the United States will be attributed to leukemia in 2007: 12.390 additional deaths. SEER (Surveillance. leukemia will be the fifth most common cause of cancer deaths in men and the sixth most common in women. There will be an estimated 8.790 Male 820 2. LEUKEMIA LYMPHOMA MYELOMA page 9 .560 5. National Cancer Institute. Despite this decline. 2.990 490 6. Cancer Statistics Review. Implications of long-term survivals in acute stem cell leukemia of childhood treated with composite cyclic therapy.
Each histologic grouping is diagnosed and treated differently.720 28. These risk factors explain only a small proportion of cases. The Epstein-Barr virus causes Burkitt’s lymphoma in Africa.190 cases of non-Hodgkin lymphoma). or low.200 38. In 2004.6 per 100. New Cases of Lymphoma by Gender. there are 138. Non-Hodgkin lymphoma is the fifth most common cancer in males and females in the United States. Incidence rates for Hodgkin lymphoma tend to be higher among males than among females. By ages 60 to 64. More than four percent of all cases of Hodgkin lymphoma diagnosed in 2007 will be in children under 15 years of age. including the presence of an abnormal cell called the ReedSternberg cell (a large.9 per 100. malignant cell found in Hodgkin lymphoma tissues). and each has prognostic factors that categorize it as more or less favorable.000 for males and 38.7 percent of all cases of non-Hodgkin lymphoma will be diagnosed in children under 15 years of age this year.190 71. eventually crowding out healthy cells and creating tumors that enlarge the lymph nodes or other sites in the body.3 per 100.380 Americans will be diagnosed with lymphoma in 2007 (8. Both Hodgkin and non-Hodgkin lymphomas are more common in males than in females. Hodgkin Lymphoma Hodgkin lymphoma is a specialized form of lymphoma and will represent about 11. Incidence by Gender Table 5 illustrates the breakdown of incidence of lymphoma by gender. Persons infected with the human immunodeficiency virus (HIV) have a much higher risk of developing lymphoma. 2007 Type Hodgkin lymphoma Non-Hodgkin lymphoma Total Male 4. Living with Lymphoma In the United States in 2007.470 34.8 percent.710 Total 8.190 cases of Hodgkin lymphoma and 63.190 63.000 for females.Hodgkin lymphoma are higher in Americans of European descent than among those of African descent. rose by 84 percent from 1975 to 2004. The bacterium Helicobacter pylori is associated with the development of lymphoma in the stomach wall. an average annual percentage increase of 2. It is the sixth most common cause of cancer deaths in males and in females.380 Table 5: Source: Cancer Facts & Figures 2007.990 32. population who are living with lymphoma.5 percent of all lymphomas diagnosed in 2007.266 members of the U.S. 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. LEUKEMIA page 10 LYMPHOMA MYELOMA .670 Female 3. 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. New Cases About 71. American Cancer Society. incidence rates for non. the difference was small. Age-specific incidence rates of non-Hodgkin lymphoma are 2. they are 52. The incidence of Hodgkin lymphoma is consistently lower than that of non-Hodgkin lymphoma. Hodgkin lymphoma has characteristics that distinguish it from all other cancers of the lymphatic system. in general whites have higher incidence rates than blacks. 2007. Fifty-three percent of the blood cancers diagnosed are lymphomas. intermediate and high grade. while 0.313 people living with Hodgkin lymphoma (active disease or in remission) and 405. The groups are often classified as indolent or aggressive.000 for females. The reasons for the development of non-Hodgkin lymphoma are not certain. Immune suppression plays a role in some patients.Lymphoma Lymphoma is a general term for a group of cancers that originates in the lymphatic system. Lymphoma results when a lymphocyte (a type of white blood cell) undergoes a malignant change and begins to multiply.953 people living with nonHodgkin lymphoma for a total of 544.000 at ages 20 to 24 for males and 1.9 per 100. After 50 to 54 years of age.
following leukemia (26. 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 83.5/1 million population). 1. Treatment for non-Hodgkin lymphoma sometimes includes vaccines and other forms of immunotherapy. The rate increases more than 18 times to 45. Incidence in Children The incidence of Hodgkin lymphoma among people under 20 years of age was 1. the highest incidence of non-Hodgkin lymphoma is in Asian/Pacific islanders.to 24year-old individuals. 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. excessive tiredness.Among women. and non-Hodgkin lymphoma.660 from non-Hodgkin lymphoma. About 2. loss of appetite and bone pain. It is rarest among American Indian/ Alaskan native children. Hispanics of all races have the second highest incidence rates of non-Hodgkin lymphoma after whites. recurrent high fever. the highest incidence of non-Hodgkin lymphoma is in non-Hispanic whites. It has remained fairly constant since 1999. armpit or groin.0/1 million population). 3. persistent fatigue.1 per 100. In children up to age 14 years. LEUKEMIA LYMPHOMA MYELOMA page 11 . Deaths An estimated 19. Death rates have been declining for Hodgkin lymphoma patients since the mid-1970s. Non-Hodgkin lymphoma is the fifth most common cancer in Hispanics. Survival for Adults Hodgkin lymphoma is now considered to be one of the most curable forms of cancer. Survival for Children Five-year relative survival is 95. chemotherapy or both may result in cures for most patients with Hodgkin lymphoma. lymphomas are most commonly diagnosed in whites (24. Early stage. troublesome itching and weight loss. The most common early sign of other forms of lymphoma is also painless swelling of the lymph nodes – usually in the neck. Incidence in Adults The incidence of non-Hodgkin lymphoma increases with age. In children from 0 to 19 years of age. Lymphomas (Hodgkin lymphoma. followed closely by Hispanic children of all races (24. depending on the tumor size. Adolescents are more commonly diagnosed with Hodgkin lymphoma than young children. night sweats.070 from Hodgkin lymphoma). Radiation. groin or in the abdomen.5 percent. about 10.1 cases per 100.000 children in 2004.730 persons will die from lymphoma in the United States in 2007 (18. 4. The five-year relative survival rate for non-Hodgkin lymphoma patients has risen from 31 percent in whites in 1960-1963 to 63. armpit.000 by ages 60 to 64.4 cases per 100. comprising nearly 5 percent of all cancers diagnosed. 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.000 people occur in 20.9 percent). sweating at night.5 percent.1 cases per 100. 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. indigestion and abdominal pain. Symptoms also often include fever. Treatment Hodgkin lymphoma is often treated with radiation and chemotherapy. In the United States. This represents a significant improvement in the rate of recovery.8 percent for all races in 1996-2003.5 percent) are the third most common cancers in children. localized non-Hodgkin lymphoma is sometimes treated with radiation. The incidence in this group decreased almost steadily and significantly between 1975 and 1999. and more than 46-fold to 112. and is the eighth most common cause of cancer death in that group. In children under 20 years of age.400 children under the age of 15 will be diagnosed with cancer in 2007.000 persons at ages 80 to 84. From ages 15 to 19. Even in the mid-1970s. Hodgkin lymphoma incidence rates are higher in adolescents and young adults than in adults in their middle years. widespread disease requires chemotherapy or chemotherapy and/or monoclonal antibody therapy with radiation.8 percent) and neoplasms of the brain and other nervous tissue (17. cell type and location of the lymphoma.
730 Male 770 9.0 2.9 3.1 63.4 2.000) 70 60 50 40 30 22.4 2.1 3.4 4.0 100. National Cancer Institute. American Cancer Society. National Cancer Institute.2 1.9 7.9 4.8 112.5 10. Epidemiology and End Results) Cancer Statistics Review 1975-2004.1 3.8 2.6 32.0 20 10 0 0. 2007. 2007.Age-Specific Incidence Rates for Hodgkin Lymphoma.4 3.0 1.1 102. 2007. 2007.6 0. * <16 cases for time interval.8 3.4 15.360 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 2007.660 19.1 0. LEUKEMIA page 12 LYMPHOMA MYELOMA . Epidemiology and End Results) Cancer Statistics Review 1975-2004.3 <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. *<16 cases per time interval. Table 6: Source: SEER (Surveillance. National Cancer Institute.9 1.060 9.8 4.4 2. Epidemiology and End Results) Cancer Statistics Review 1975-2004.4 2.370 Female 300 9.1 4.0 45.1 0.0 0.070 18.2 4.600 10. 2000-2004 110 100 90 80 Incidence (per 100. 2000-2004 6 Incidence (per 100. Age-Specific Incidence Rates for Non-Hodgkin Lymphoma.0 3.3 4.5 <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.4 80.000) 5 4 3 2 1 0 0. 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.
The onset of myeloma interferes with normal production of antibodies and makes myeloma patients susceptible to infections. New Cases An estimated 19. but primarily in the bone marrow. 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 median age at diagnosis for African-Americans is 67. has been increasing. two or three drugs are used simultaneously. It grows continuously and forms masses of plasma cells. the cell that forms plasma cells. Myeloma was the 10th most common cause of cancer deaths for women in 2000-2004. SEER 17 areas (<1. LEUKEMIA LYMPHOMA MYELOMA page 13 . Living with Myeloma An estimated 60. • The median age at diagnosis is 70.000) is 56 percent higher than for women (4.5/100.000).1 0.000) 40 30 20 10 0 0-24 0.3 0.1 21.000) of myeloma than those of European descent (5. Treatment may include intensive chemotherapy followed by stem cell transplantation to restore normal blood cell production. The U.1 Signs and Symptoms Often the first symptom of myeloma is bone pain caused by the effects of myeloma cells in the marrow.8 14. The mortality rate from myeloma for people of African descent is more than double the rate for whites (7. Approximately 3 percent of all cancer-related deaths among AfricanAmericans in 2000-2004 were from myeloma.790 deaths from myeloma are anticipated this year. Thalidomide is approved by the FDA for use in treating newly diagnosed myeloma.000). Treatment is aimed at slowing progress of the disease. (11.940 women) new cases of myeloma will be diagnosed in the United States in 2007. Age-Specific Incidence Rates for Myeloma. Patients may have anemia. It is 71 for African-Americans. 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. From 2000 to 2004.4 35. especially. myeloma was the 10th most commonly diagnosed cancer among African-American men and women. Figure 9: Source: SEER (Surveillance. destroying normal bone tissue. 5-9.Myeloma Myeloma is a cancer of the plasma cells. especially in the marrow.1 28. • The incidence rate in men (7/100. Sixty percent of those were diagnosed with the disease within the past four years. and it rarely occurs in people under age 45.S. becomes malignant. • Americans of African descent have a much higher incidence rate. Epidemiology and End Results) Cancer Statistics Review 1975-2004. 2007. Fractures may occur as a result of the weakened bones.424 people in the United States are living with myeloma.5 3. 15-19.4 33. the patient’s own stem cells are used (autologous stem cell infusion).960 men and 8. 20-24). approximately double. causing pain and crowding out normal blood cell production.3/100.9 9. Deaths Approximately 10. 10-14. Recurrent infections may be an early sign of the disease. 1-4. Total survival for white males.7 1.0 37.2/100. tire more easily and feel weak. but it is the most difficult blood cancer to treat successfully.1/100.5/100.000). National Cancer Institute.1 5. *<16 cases for each age interval. 2000-2004 Incidence (per 100. 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. Lenalidomide is approved by the FDA in combination with dexamethasone for the treatment of myeloma patients who have received at least one prior therapy. Usually.000 to 3. median age at death from multiple myeloma is 74. At times. a B lymphocyte. In myeloma. Treatment Chemotherapy for myeloma has led to sustained remissions in some patients.900 (10. Malignant plasma cells produce an abnormal protein called monoclonal immunoglobulin.000) for all racial and ethnic groups. Bortezomib has been approved for treating myeloma in patients who have had at least two prior therapies. a type of white blood cell found in many tissues of the body. The highest rates are found in black men 80 to 84 years of age and older (105/100.
7 24.9 5.1 2.000 Population (2000-2004) Type Leukemia Non-Hodgkin lymphoma Hodgkin lymphoma Myeloma Overall 12. Epidemiology and End Results) Cancer Statistics Review 1975-2004.3 2.1 11. All Races.2 2. for Whites.0 23.0 2.6 Female 9.000 population and are age-adjusted to the 2000 population.3 Male 13. 2007.000 Population (2000-2004) Type Leukemia Non-Hodgkin lymphoma Hodgkin lymphoma Myeloma Overall 12.9 2. National Cancer Institute.6 2. (Based on SEER 17 areas. Hodgkin and non-Hodgkin lymphoma and myeloma use figures from 2000-2004.2 6.6 Male 16.3 2.2 3. for Blacks. (Based on SEER 17 areas. per 100.0 Female 8.) Incidence Rates by Gender. National Cancer Institute. the most recent available.8 20.5 Table 8: Source: SEER (Surveillance. Lymphoma and Myeloma The following tables showing incidence rates for leukemia. per 100.8 14.2 Male 16.Incidence Rates: Leukemia. National Cancer Institute. Rates are per 100.5 16.3 19.) Table 9: Source: SEER (Surveillance.6 4. Epidemiology and End Results) Cancer Statistics Review 1975-2004.1 Table 10: Source: SEER (Surveillance.1 9.0 7.2 18.4 4.5 Incidence Rates by Gender.000 Population (2000-2004) Type Leukemia Non-Hodgkin lymphoma Hodgkin lymphoma Myeloma Overall 10. Epidemiology and End Results) Cancer Statistics Review 1975-2004.2 14.9 17. (Based on SEER 17 areas. 2007.1 3.4 11.0 Female 9.7 5. per 100. 2007.) LEUKEMIA page 14 LYMPHOMA MYELOMA . Incidence Rates by Gender.
390 1.410 130 50 500 490 130 490 * 21.560 770 890 3. American Cancer Society. Used with permission.510 500 60 70 900 380 220 160 280 430 100 370 460 730 310 170 400 70 110 120 80 650 120 1.Estimated New Cases of Blood Cancers by Site. **State estimates may not add up to U.030 910 620 420 680 680 250 630 1.240 740 80 1. Table 12: Sources: Cancer Facts & Figures 2007.250 1. Centers for Disease Control and Prevention. is described by Pickle et al.370 100 * 430 380 130 350 * 19.360 610 * 950 290 260 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** 350 * 400 240 2.540 1. and additional data supplied by the American Cancer Society based on data from the U. Numbers are rounded to the nearest 10..010 1.630 540 80 120 990 510 310 230 320 330 100 390 490 770 400 210 460 80 150 160 100 680 120 1.140 60 260 80 410 1. 2006. 2007.310 800 600 900 920 330 1.500 430 1. CA A Cancer Journal for Clinicians.030 570 * 610 210 360 1.300 470 90 100 750 430 300 220 290 310 110 320 420 660 350 170 500 80 110 130 90 600 120 1. American Cancer Society.200 350 4. *Estimate is fewer than 50 cases. National Center for Health Statistics.S.150 290 270 70 * 1.790 330 * 320 200 1. model (see below).140 380 140 1.130 300 80 900 960 300 1. total because of rounding and exclusion of estimates that are fewer than 50 cases. 2007 State Leukemia Non-Hodgkin Lymphoma Myeloma Hodgkin Lymphoma*** Estimated Deaths from Blood Cancers by Site. and additional data supplied by the American Cancer Society.240 170 550 130 800 3.050 140 140 * * 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 * 10.520 310 3.070 Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist.670 1.550 2.880 240 250 50 50 1. ***Hodgkin lymphoma estimates are not available for 2007.610 150 2. Used with permission.070 80 330 70 480 1.S.550 * * * * *20 * * * * 60 * * * 50 * * * * * * * * * * * * * * * * * * 70 * * 50 * * 60 * * * * 80 * * * * * * * 390 Table 11: Sources: Cancer Facts & Figures 2007. 2007.190 290 * 280 200 1.710 570 500 2.610 670 610 110 60 3. Note: These estimates are offered as a rough guide and should be interpreted with caution.300 110 63.680 920 340 890 170 290 330 190 1.160 1. 2007 State Leukemia Non-Hodgkin Lymphoma Myeloma Hodgkin Lymphoma Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist.190 880 870 170 100 4. which is new for 2007. 1969-2004. *Estimate is fewer than 50 cases.830 240 230 60 * 1. numbers are small and NCI and ACS are having difficulty fitting them into the Pickle et al. The method of derivation.660 210 * 190 120 1.260 220 400 420 290 2.S. total because of rounding and exclusion of estimates that are fewer than 50 cases. Numbers are rounded to the nearest 10. Mortality Public Use Data Tapes. **State estimates may not add up to U. They cannot be compared with previous years’ estimates to determine cancer incidence trends.080 1. LEUKEMIA LYMPHOMA MYELOMA page 15 .360 960 170 220 2.330 260 780 180 1.370 250 280 2.530 1.080 600 7.410 560 * 740 230 230 930 70 300 50 350 1. by State. January/February 2007.040 70 44. 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. by State.180 4.170 480 1. Note: These estimates are offered as a rough guide and should be interpreted with caution.160 140 50 360 440 170 320 * 18.070 110 1.
Definitions Incidence is the number of newly diagnosed cases for a specific cancer or for all cancers combined during a specific time period. his or her survival with leukemia may not be counted in leukemia prevalence statistics. it is the number of new cases per standard unit of population during the time period.S. 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. mostly upward. This year. race or sex. Relative survival rate is an estimate of the percentage of patients who would be expected to survive the effects of the cancer. the American Cancer Society changed its method of estimating cancer incidence. Incidence rates can be calculated based on a number of factors such as age. if a person is initially diagnosed with melanoma and later develops leukemia. (Observed survival is the actual percentage of patients still alive at some specified time after diagnosis of cancer. January/February 2007. Prevalence may be calculated in a number of different ways. prevalence numbers reported may vary depending upon the method used to determine them. Epidemiology and End Results Program (SEER) regions (or.) Prevalence is the estimated number of people alive on a certain date in a population who previously had a diagnosis of the disease. The SEER (17 region) data cover only about 26 percent of the U. When expressed as a rate.S. CA A Cancer Journal for Clinicians. in some cases fewer than 17 SEER regions) and death data from the National Center for Health Statistics. 2007.. It includes new (incidence) and preexisting cases and is a function of both past incidence and survival. only the first diagnosed cancer counts. Because of reporting delays from some of the SEER regions. The data presented in this report are an extrapolation or estimate of the number of cases reported by the 17 Surveillance. LEUKEMIA page 16 LYMPHOMA MYELOMA . no matter how long ago that diagnosis was. The data can be extrapolated for the entire United States by multiplying by the population ratio. The relative survival rate is a comparison of survival to a person who is free of the disease. Thus. 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. especially in looking at populations in which individuals have had more than one type of cancer.Notes and Definitions Notes The United States does not have a nationwide reporting system or registry for blood cancers. based on the “first invasive tumor for each cancer site diagnosed during the previous 29 years (1975-2003). This change means that the 2007 incidence estimates are not comparable with previous estimates for determining cancer incidence trends. Bureau of the Census’ 2000 population data for that region. The specified date is 1/1/2004 for the prevalence estimates. may be incomplete in some cases and the data may reflect adjustments that anticipate changes that will occur once the actual data are received. state-by-state data for incidence of Hodgkin lymphoma are not available because these numbers are so small. It considers deaths from all causes. race and ethnicity in various regions and region-specific health risks. 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. In some prevalence statistics. the data presented in the 2007 SEER report placed online on April 15. The description of the methods used was published in Pickle et al.S.” as per SEER table I-21. survival and mortality have been revised. population) that belong to the National Program of Cancer Registries. population. in comparison to the 2002 SEER report. estimates of cancer incidence.” We are using the “29-year limited duration” prevalence figures. Census. 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. 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. Thus. 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. so the exact number of cases is not known. In this report. Because of this change in method. Because of changes in the information — such as racial classification — gathered in the 2000 U. cancer or otherwise.S. but these figures do not take into account differences in geography.
12. Barr R. Atlanta: American Cancer Society. 2007. http://www. Sheaffer J.org/cgi/content/full/57/1/30. MD. http://seer. Shu X-O. Bleyer A. O’Leary M. Hachey M. 2006. Howlander N. 2007. National Cancer Institute. Barr R. posted to the SEER Web site 2007. SEER (Surveillance. Horner MJ. “Highlights and Challenges. pp.com/cgi/content/full/12/1/20. MD. and End Results) Cancer Statistics Review. O’Leary M. Miller BA. 065767. Atlanta: American Cancer Society. Mariotto A. National Cancer Institute. The Oncologist Vol. 25-38.” O’Leary M. Bethesda. National Cancer Institute. Stock W. Including SEER Incidence and Survival: 1975-2000. Barr R. Nachman J. Howlader N. pp. January/February. “Lymphomas and Reticuloendothelial Neoplasms. Bethesda. Feuer EJ. Bethesda. http://caonline. 20-37. No. Ries LAG (eds). January.gov/csr/1975_2004/ LEUKEMIA LYMPHOMA MYELOMA page 17 . Ross J. 2006. Cheson B. Barr R. “A New Method of Estimating United States and State-Level Cancer Incidence Counts for the Current Calendar Year. 1975-2004. In Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age. Jemal A.Citations Source Citations Cancer Facts & Figures 2007. Clegg L. No. MD. Tiwari RC. “Cancer Statistics. 39-51.” Pickle LW. In Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age. Epidemiology. and End Results (SEER) Program. 30-42. Edwards BK (eds). Including SEER Incidence and Survival: 1975-2000. Hao Y. National Cancer Institute.cancer. based on November 2006 SEER data submission. “Leukemias. Ries LAG (eds). Feuer EJ. Cancer Facts & Figures for African Americans 2007-2008. pp. Ward E. Melbert D. Zou Z. Ries LAG. Reichman ME. pp. and Multiple Primary Cancer Analyses from the Surveillance.” Bleyer A. Keller F.” Mattano L Jr. NIH Pub. 174. p. Including SEER Incidence and Survival: 1975-2000.TheOncologist. Bleyer A. Reichman M. Trends. 065767. 2007. Bethesda. No. In Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age. NIH Pub. O’Leary M.” Hayat MJ.amcancersoc. Howe HL. Bleyer A. 2006. 06-5767. Eisner MP. Edwards BK. Ries LAG (eds). 57. Krapcho M. MD. Epidemiology. 2007. CA A Cancer Journal for Clinicians Vol. NIH Pub.
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 and the Specialized Center of Research (SCOR). the Society’s grant programs are among the most prestigious in the fields of blood cancers. • Special Fellows in Clinical Research are awarded $60. are granted each year. Special Fellows and Fellows) pursuing careers and is stratified into two separately reviewed programs in basic or clinical research: Basic Research • Scholars are awarded $110.25 million per year over a five-year period.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. 3) Translational Research Program.6 million annually on research. lymphoma and myeloma should be encouraged worldwide.000 over five years.000 over three years. or control of. Awards go to those groups that best demonstrate the synergy that will occur from their close interaction. Since the first funding in 1954. The SCOR program brings together research teams working in complementary areas. The SCOR grants also support scientific core laboratories to provide access to innovative technology if required by the participating research programs. The program is expected to generate new knowledge and breakthrough discoveries. lymphoma.000. diagnosis or prevention in the near term. lymphoma and myeloma research comprise four review subcomittees. for a total of $600. Hodgkin’s disease and myeloma. Thus. 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. 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.000 a year for a total of $550.000 a year for a total of $550. The Specialized Center of Research (SCOR) in Leukemia. Translational Research Awards are made for an initial three-year period. and improve the quality of life of patients and their families. lymphoma or myeloma. The participating scientists may be at different institutions or from any country.000 a year for a total of $150. • Special Fellows are awarded $60. 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.000 over three years. Each SCOR is funded up to $1. Research Research Grant Programs The Society’s research programs are based on the belief that all scientifically sound approaches toward a cure for.000 per year for three years. Career Development Program The Career Development Program supports promising young scientists (Scholars.000 over five years. treatment or prevention of leukemia. to a total cost of $6. Funding for two additional years may be provided for highly promising projects that are entering phase I clinical trial.000 over three years. The Society is a nonprofit organization that relies on the generosity of individual and corporate contributions to advance its mission. Translational Research Program The Translational Research Program provides early-stage support for research on leukemia.000 a year for a total of $180. lymphoma and myeloma that is intended to advance treatment.25 million. research reaching a clinical trial can receive $1 million over five years to facilitate new drug discovery or advances in diagnosis or prevention. We offer a wide variety of programs and services in support of our mission: Cure leukemia. leukemia.000 a year for a total of $180. 2) CDP-clinical research. Now supporting $61. each focused on the discovery of new approaches to benefit patients or those at risk for developing leukemia. Awards up to $200. leading to better survival rates and prevention measures for patients. They are: 1) Career Development Program (CDP)-basic research.
org. The educational program offers varying formats to facilitate the exchange of information and ideas on the newest developments in cancer research and treatment. As of June 30.LLS. www. Co-Pay Assistance Program Patients with AML. This support should advance the understanding. These include the Stohlman Scholar Symposium. www. Patients needing assistance may apply on the Society’s Web site. 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. myeloma. audio. Professional Education The Society serves the continuing educational needs of the medical and research community through professional symposia offered throughout the year.important projects to advance the Society’s mission.m. 9 a. and applications for the Society’s three research programs may be obtained by visiting www. These offices conduct lifeenhancing patient services. It is continually being updated and expanded to support and promote the Society’s mission. from 10:00 a. Guidelines. instructions. serves a wide variety of education and information needs. the Society distributes more than 1 million booklets. ET.m.org. The Annual Research Symposium. Other meetings are held for the Society’s grantees.org.org or by or emailing researchprograms@LLS. to 6 p. call (877) LLS-COPAY ( 557-2672) or email copay@LLS.LLS.org/copay. Information on registration for these free events can be accessed at www.org or faxing to (914) 949-6691 or contacting the Research Department at (914) 949-5213. They are available to talk one-onone. The Society’s Web Site The Society’s Web site. their families and healthcare professionals. peer counseling and patient financial aid. on the Society’s Web site. lymphoma. Patients. the Society’s programs and services. Family Support Group locations. The Society also hosts numerous teleconferences and Webcasts. www. Much of the content of these materials is available to view and download at www. friends and healthcare professionals. sponsored by the Society.” Chapter Programs: Family Support Groups: The Society has developed more than 360 Family Support Groups at 68 chapters. Each year. LEUKEMIA LYMPHOMA MYELOMA page 19 . and click “Live Help.org. podcasts and Webcast archives of these programs are available at www. brochures and videos through the IRC and local Society chapters. The site features a comprehensive overview of blood cancers. to 5:00 p. treatments. treatment and prevention of leukemia.org. Information Resource Center (IRC) The Society strives to be the world’s foremost source of information on leukemia.LLS. Information specialists are oncology social workers and health educators who provide callers with current information on blood cancers. myelodysplastic syndromes (MDS) and other blood cancers.LLS.LLS. each group provides information and support.LLS. Educational Materials An extensive collection of free educational materials are offered to patients and health professionals.m. ET. is held each December on the Friday immediately before the American Society of Hematology meeting. lymphoma. where medical professionals share the latest research findings. Teleconferences and Webcasts The Society sponsors more than 25 educational teleconferences and Webcasts each year on topics of interest to patients and caregivers. including support groups. The Society funds several Focused Workshops each year on important topics relevant to hematological malignancies. First Connection: This program links newly diagnosed patients to a peer volunteer who has experienced a similar diagnosis. A trained patient volunteer currently in remission phones the new patient to share information and support. Monday through Friday. and encourages greater communication among patients. Guided by two volunteer oncology health professionals.LLS. The IRC is a worldwide link to information and resources useful to patients. the Translational Research Grant Progress Review Meeting and the SCOR Progress Review Meeting.m. You may also chat online with an information specialist.org. 2007 the Society will have 379 active grantees at 116 institutions in the United States and abroad. families. Patient Services The Society has a network of 68 chapters throughout the United States and Canada. information about our peer-to-peer program First Connection and other programs. The user has the opportunity to create personalized pages with identified interests. clinical trials and offer guidance on coping. lymphoma and myeloma.org. families and professionals may call the IRC toll free at (800) 955-4572 in addition to corresponding by email at infocenter@LLS.
In 2001. 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. Patient financial aid funds are subject to availability. It is supported by Amgen Oncology. This program is being sponsored by an unrestricted education grant from Novartis Oncology. That network now numbers more than 35. CML Issues and Insights: A Nursing Education Program on Chronic Myelogenous Leukemia. 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. 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. In 2002. Working through chapters across the country. treatments. Society volunteers and staff visit Capitol Hill regularly to lobby Congress in support of issues that impact research and patient care. LEUKEMIA page 20 LYMPHOMA MYELOMA . The patient education program was funded at $18 million through 2007. drugs and various treatments not covered by insurance.Patient Financial Aid Program: For more than 31 years.org and is being sponsored by a generous. the Society has helped patients demonstrating a need for financial assistance cover a portion of their treatment costs. the Society’s advocacy program has been a strong voice in Washington. Department of Defense’s medical research program. The Society has identified key issues that currently shape its advocacy agenda. New Directions in Myeloma Therapy: This program presents an overview of myeloma. that program has funded some $30 million in additional blood cancer research. and offers numerous resources that can assist childhood cancer survivors to flourish in the school environment posttreatment. videos and other materials to aid the process are available through all local chapters. treatments. Advocacy Since 1994. Meet the Expert on Non-Hodgkin Lymphoma: This program presents basic information on terminology. The Trish Greene Back to School Program for Children with Cancer: This program is designed to increase communication among healthcare professionals. the Society successfully lobbied Congress to institute a blood cancer research initiative as part of the U. emerging therapies and side effects and addresses the unique challenges of nursing management of these patients. New insights. The Path to Progress: Clinical Trials in Blood Cancers: This program provides patients. risk factors. parents.LLS. 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. This nursing education program provides an overview of CML. patients and school personnel to assure youngsters a smooth transition from active treatment back to school. Through the Patient Financial Aid Program.000 and has become a potent voice in public policy deliberations.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. On the state level. Printed literature. how cancer drugs are developed and what the emerging treatment options are for leukemia. This program is provided through an unrestricted educational grant from Millennium Pharmaceuticals.and long-term effects that children may experience after treatment. Welcome Back: Facilitating the Return to School for Children with Cancer: A new addition to The Trish Greene Back to School Program. This Society program is being supported by Celgene Corporation and Millennium Pharmaceuticals. staging and classification of nonHodgkin lymphoma (NHL). This program is made possible by the Lance Armstrong Foundation. treatments and future directions for NHL are also discussed. This program is also accessible as a Webcast at www. unrestricted educational grant from Genentech BioOncology and Biogen Idec Inc. families and healthcare professionals with a clear description of what clinical trials are. emerging therapies and managing side effects and how to find emotional support when living with the illness. reimbursement of up to $500 per year helps cover the costs of transportation. representing to policy makers at all levels of government the healthcare quality concerns and medical research interests of patients and their families. providing additional support for blood cancer patients and their families nationwide. DC. lymphoma and myeloma. diagnosis. To date. this education program discusses possible emotional and cognitive short.
of the American Cancer Society (ACS). with the understanding that the Society is not engaged in rendering medical or other professional services. The Leukemia & Lymphoma Society extends special thanks to Myrna Watanabe.Acknowledgements Additional data from SEER*Stat Databases at http://www. It is distributed as a public service by The Leukemia & Lymphoma Society Inc.gov.. This publication is designed to provide information in regard to the subject matter covered. . provided ACS’s state-by-state statistics on myeloma and Hodgkin lymphoma. provided statistical assistance.cancer.seer.D. for compilation of data for this publication. Ph. and Rebecca Siegel. NCI. Milton Eisner of SEER.
LLS Information Resource Center (IRC): 800. lymphoma.4572 www.955.Home Office 1311 Mamaroneck Avenue. Hodgkin’s disease and myeloma. corporate and foundation contributions to advance its mission. PS80 35M 6/07 .HELP.LLS. The Society is a nonprofit organization that relies on the generosity of individual. New York 10605 Tel: 888.org Our mission: Cure leukemia. Suite 310 White Plains. and improve the quality of life of patients and their families.
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