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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.
660 from non-Hodgkin). LEUKEMIA LYMPHOMA MYELOMA page 1 . the National Cancer Institute’s Surveillance. Highlights from the Report Include: New Cases • An estimated 135. Hodgkin and non-Hodgkin lymphoma.266 people living today with lymphoma. This year. 1998.380 new cases of lymphoma will be diagnosed in the United States (8.190 cases of Hodgkin.190 cases of non-Hodgkin). lymphoma and myeloma decreased from 1995 to 2004 (the last year data were available). 21. • Every five minutes. 44. or nearly six people every hour. and its age-adjusted incidence rose by nearly 84 percent from 1975 to 2004.240 people will be diagnosed with leukemia. 10. • These blood cancers will account for 9. 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. page 16). 71. • Thirty-two percent more males are living with leukemia than females.900 people will be diagnosed with myeloma. • In general. • In 2007. Survival • An estimated 823. which becomes malignant and multiplies continuously. National Cancer Institute. someone is diagnosed with a blood cancer.349 Americans are living with leukemia.gov. 63.cancer. 1996. Deaths • Leukemia. the likelihood of dying from most leukemias*. Oxford University Press. This abnormal accumulation interferes with the production of healthy blood cells. More males are diagnosed with leukemia and more males die of it than females. These data were published online by SEER. • This year. • Eighty-six percent of myeloma cases occur in people aged 55 and over. • In 2007. 2nd Edition. • This year. lymphoma and myeloma.313 either have or are in remission from Hodgkin lymphoma. an annual publication. From 1975 to 2004. *except acute myelogenous leukemia (AML) and other. The data within Facts 2007-2008 reflect the most recent statistics available from SEER.790 people will die of leukemia.310 people in the United States this year.730 people will die from lymphoma (1.650 total cancer-related deaths. 2007 and SEER 19731993. the incidence of myeloma increased 8 percent. 19.790 people will die from myeloma. 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. is a compilation of the most recent data on leukemia. The next SEER Cancer Statistics Review is expected to be published online in April 2008. 19. This statistic represents 143 people each day. in April 2007. 138.4 percent of the 1.3 percent of the deaths from cancer in 2007 based on the 559. 1975-2004. someone dies from a blood cancer. www. Epidemiology and End Results Program. • Every 10 minutes.424 people living today with myeloma. *Myeloma Biology and Management. • Leukemia causes more deaths than any other cancer among children and young adults under the age of 20. • Non-Hodgkin lymphoma is the fifth most common cancer in the United States. Mortality from the disease increased 24 percent. National Cancer Institute. Myeloma: • • • • There are 60. 405. lymphoma and myeloma in 2007.444.920 new cancer cases diagnosed in the United States this year. • New cases of leukemia.520 people in the United States will be diagnosed with leukemia. 18. and myeloma.1975-1977 vs.seer. Epidemiology and End Results) Cancer Statistics Review.Executive Summary Facts 2007-2008. Cancer Statistics Review 1975-2004 (see Notes. nonacute myelogenous and monocytic leukemias Lymphoma: • There are 544. Five-Year Relative Survival Rates 1960-1963 vs.659 people in the United States who are either living with or are in remission from leukemia. 1960-1963 1975-1977 1996-2003 Figure 1: Sources: SEER (Surveillance. Hodgkin and non-Hodgkin lymphoma and myeloma will account for nearly 9.953 either have or are in remission from non-Hodgkin lymphoma (NHL).070 from Hodgkin. This year. Leukemia. lymphoma and myeloma will cause the deaths of an estimated 52.
Stem cells also circulate in large numbers in fetal blood and can be recovered from umbilical cord and placental blood after childbirth. for which a parent rather than a sibling could be the donor. Research is being conducted to improve socalled “haploidentical” transplant. The numbers of stem cells in cord blood are often insufficient for the needs Figure 2: Source: Cancer Facts & Figures. Autologous transplantation uses the patient’s own marrow stem cells and is technically not transplantation since another person is not the donor. Hodgkin and non-Hodgkin lymphoma and myeloma are cancers that originate in a cell in the bone marrow or lymphatic tissues. Patients with acute lymphocytic leukemia (ALL).About the Diseases Leukemia. There are two major types of stem cell transplants: syngeneic and allogeneic. 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. Such an approach would greatly lessen the proportion of children without a donor. (Numbers do not add up to 100% because of rounding. freezing and storing of cord blood have provided another source of stem cells for transplantation. studies suggest that two matched cord donors may result in a higher success rate in larger adults. The harvesting. 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. The blood or marrow stem cells are collected while the patient is in remission. is largely responsible for the dramatic improvement in managing leukemia and lymphoma. The technique of harvesting stem cells from blood and cord blood has made transplantation available for more LEUKEMIA page 2 LYMPHOMA MYELOMA . These diseases usually result from an acquired genetic injury to the DNA of a single cell. myeloma and lymphoma are usually treated with chemotherapy. 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. An allogeneic transplant uses blood or marrow stem cells from a normal donor. some types of Hodgkin lymphoma. lymphoma and myeloma. slightly mismatched cord stem cell donors may be used quite successfully. usually in combinations of two or more drugs. In special instances. Patients with leukemia.) of larger adult patients. a search of the National Marrow Donor Program registry of tissue-typed volunteers could be made for a matched unrelated donor. Syngeneic transplant describes the use of an identical twin as donor. especially for children. They are considered to be related cancers because they arise from cells with a common origin (the lymphohematopoietic stem cells) and with related functions. decreased ability to fight infections and a predisposition to bleeding. usually a brother or sister with the same tissue type. Estimated New Cases (%) of Blood Cancers in 2007 Myeloma 15% Leukemia 33% Lymphoma 53% Treatment Chemotherapy and Radiotherapy: The use of chemotherapy (anticancer drugs). American Cancer Society. 2007. 2007. Approximately 50 different drugs are now being used in the treatment of these diseases. which becomes abnormal (malignant) and multiplies continuously. especially in young children. The technique is important. 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. However. The accumulation of malignant cells interferes with the body’s production of normal blood or immune cells and can result in severe anemia. If a sibling is not available. 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.
Most follow-up clinics specialize in pediatric cancer survivors.childrensoncologygroup. donors of blood stem cells require special treatment to mobilize sufficient stem cells from marrow into their blood before cells are harvested. Follow-Up Guidelines: The Children’s Oncology Group has established Long-Term Follow-Up Guidelines for Survivors of Childhood. Identifying these biomarkers will allow researchers to develop tests that can predict what effects an individual is at risk of developing. In standard stem cell transplantation. Coordination between specialists and primary care physicians is essential to provide the best care possible. To ensure there will be enough blood stem cells for successful transplantation. This “graft versus leukemia or lymphoma effect” can suppress (cure) the malignancy and is a prolonged (indefinite) form of immunotherapy. Imatinib mesylate (Gleevec®) is now the drug of choice in newly diagnosed patients with chronic myelogenous leukemia (CML). In nonablative transplantation. Over time. Cancers (http://www. marrow and immune system. 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. frozen and stored and later transplanted in the patient. This still experimental approach greatly lessens the early toxicity of transplantation and has extended the age at which recipients with leukemia. but some follow adult cancer survivors. “Ablation” referred to wipingout the recipient’s cancer. identify recurrence of the disease and detect long-term or late effects. the donor’s cells take hold and the patient’s leukemia. Cancer survivors should see their primary care physicians for general health examinations and an oncologist for follow-up care related to cancer. Development of New Drugs: In the past decade. few severe adverse effects on normal tissues and a very high response rate. these cells can be harvested from the blood of a donor. lymphoma or myeloma can have an allogeneic transplant.patients. It works by blocking the oncogeneencoded protein product that instigates the transformation to a leukemic cell. making the procedure more tolerable. 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. New Approaches to Treatment Several areas of research have resulted in new approaches to the treatment of leukemia. Regular examinations may include screening for cancer recurrence or the development of secondary cancer or other late effects of treatment. Although a minority of patients have developed resistance to the drug.org/). multi-disciplinary approach to monitoring and supporting cancer survivors. Gleevec offers several dramatic advantages to patients: oral administration. is a source of stem cells for transplantation. Adolescent. The protein is an enzyme in the family of tyrosine kinases. two second-generation agents. and Young Adult LEUKEMIA LYMPHOMA MYELOMA page 3 . ablation of the recipient’s blood-cell forming and immune cells was the price that had to be paid to eradicate the leukemia. lymphoma or myeloma and permit the donor’s cells to be accepted by the temporarily immunodeficient recipient. as needed. 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. the recipient’s blood cell and immune system are preserved. lymphoma or myeloma is attacked and suppressed by donor lymphocytes that form from the donor stem cells. Because blood. 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. decreased side effects. thereby allowing doctors to plan treatment accordingly. Stem cells not only reside in the marrow but also circulate in the blood. lymphoma and myeloma. or genetic factors that can increase susceptibility to certain effects. “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. Cancer survivors should have physical examinations yearly or more often. Biomarkers could be high levels of certain substances in the body such as antibodies or hormones. several important new drugs and new uses for existing drugs have greatly improved cure rates or remission duration for some patients with leukemia. as well as marrow. Blood and cord blood transplants differ from marrow transplants principally in the source of the cells collected for transplant. 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.
Monoclonal Antibody Therapy: Monoclonal antibodies are laboratory-produced proteins that can be infused into an appropriate patient. symptomatic anemia have improvement in hemoglobin levels with this agent. thalidomide (Thalomid®). Food and Drug Administration [FDA] in 2006) and nilotinib (in clinical trials). Indeed. has improved dramatically with the introduction of cladribine. a less common type of chronic lymphocytic leukemia (CLL). 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. Immunotherapy: This is a treatment that uses immune cells or antibodies to fight the disease.dasatinib (Sprycel®)(approved by the U. and Decitabine (Dacogen®). Lenalidomide (Revlimid®). Other therapies in clinical research to treat MDS include arsenic trixoxide. such as follicular lymphoma. Rituximab is an antibody directed at the target CD20 antigen on B-cell lymphoma cells. Azacitidine (Vidaza®). kill unhealthy bone marrow cells and may help the bone marrow function more normally in MDS patients. however. This drug is also being tested in clinical trials to treat adult acute leukemia and MDS. Pentostatin is another effective drug that can be used in patients with hairy cell leukemia who do not respond to cladribine. The treatment of hairy cell leukemia. although initially used in indolent lymphomas. a thalidomide derivative. cyclophosphamide. Alemtuzumab (Campath®) is a monoclonal antibody directed against the antigen CD52 found on T and B lymphocytes. Cladribine induces long-term remissions in nearly 90 percent of patients treated at diagnosis for one week. was approved by the FDA for newly diagnosed myeloma. In patients with anemia. approved by the FDA in 2005. Rituximab has become an important agent to treat CD20-positive lymphocytic malignancies. Gleevec is not only a very important new agent in the treatment of CML. it has now become an important fifth drug in the R-CHOP–rituximab. principally. are entering clinical use and can overcome this resistance in some cases. immune cell administration and vaccine development. the most prevalent lymphoma subtype. thus rituximab is an anti-CD20 antibody. Early studies indicate the combination of arsenic trioxide and all-trans retinoic acid may be a further advance in the initiation of therapy. and enhances the specificity of treatment to minimize toxic effects on normal tissues. Three types of immunotherapy are being explored: antibody treatment. has been approved by the FDA for the treatment of a specific type of myelodysplastic syndrome (MDS) that results from an alteration in chromosome 5. Monoclonal antibodies have added to the arsenal of agents that are used for the treatment of patients with lymphoma and leukemia. Revlimid is approved by the FDA in combination with dexamethasone for the treatment of myeloma patients who have received at least one prior therapy. PDGFR or KIT oncoproteins). perhaps 20 percent of cases also derive benefit. is being used to treat relapsed or refractory acute lymphocytic leukemia (ALL) in children who have received at least two prior therapies. 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. Some patients with moderately severe. farnesyl transferase inhibitors and reduced-intensity stem cell transplantation. vincristine (Oncovin®) and prednisone–therapy for diffuse large B-cell lymphoma. LEUKEMIA page 4 LYMPHOMA MYELOMA . Velcade is approved by the FDA for treating people with myeloma who have had at least one prior therapy. Arsenic trioxide also adds to the drugs available to treat this subtype of acute 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®). 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). Clofarabine (Clolar®). suppresses the progression of leukemia. It is especially active against the lymphocytes in CLL. in combination with dexamethasone. Patients with more severe forms of MDS are very unlikely to respond to the agent. In May 2006. doxorubicin (Adriamycin®). 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. but without this specific chromosome 5 abnormality. chronic eosinophilic leukemia (formerly hypereosinophilic syndrome).S. lymphoma or myeloma. approved by the FDA for all types of MDS. reducing the need for transfusions in some patients. but it can also induce remissions in some cases of acute leukemia. Cell surface antigens have been given a cluster designation (CD) followed by a number.
the patient’s immune cells would be treated in the laboratory to train them to attack the residual leukemia. a technique that prepares small molecules in the laboratory that have the ability to inactivate proteins that cause disease. The goal is to extend the duration of remission achieved by remissioninduction therapy of various types. They deliver the toxic substance directly to the cancer cells. These cells are. or become. If the gene in the former case is an oncogene or the protein in the latter case is an oncoprotein. The goal of several new agents being studied is to decrease resistance to an important chemotherapy drug used in leukemia. This drug. the infusion of the original marrow donor’s lymphocytes can re-induce remission. Vaccines: Experimental treatment vaccines are now being studied to treat certain types of lymphoma. Reversal of Multidrug Resistance: The malignant cells of patients have mechanisms that may allow them to escape the damaging effects of chemotherapy agents. lymphoma and myeloma. Vaccines are in clinical trials for types of acute and chronic leukemia. new forms of cancer therapy may be developed.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. In each case. In some approaches. 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. These are called conjugated monoclonal antibodies. gemtuzumab (Mylotarg®). LEUKEMIA LYMPHOMA MYELOMA page 5 . Approaches to reversing multidrug resistance are under study. b) a modality that uses molecules of RNA to silence complementary (DNA) genes. Monoclonal antibodies can also be linked to a radioactive isotope to target and kill specific cancer cells. In another approach. Studies of vaccines used in patients with follicular or indolent lymphoma have demonstrated an immune response. Paradoxically. 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. This type of treatment is being studied intensively to learn more about the basis for this immune cell effect and to expand it for use in other situations. and aptamer treatment. cells are isolated in the laboratory and start making antibodies after insertion of the cancer antigen. Two new and potentially important approaches include a) the application of RNA interference. In patients with CML who have relapsed after stem cell transplantation. In one approach. lymphoma or myeloma cells. drugs are designed to interfere with the oncoprotein and prevent its effect on the cell. An alternative strategy called molecular targeted drug development targets the oncoprotein. These drugs have been approved to treat relapsed B-cell non-Hodgkin lymphoma. less responsive to therapy. 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. Patients with myeloma have also had remission re-induced by donor lymphocytes. Many cancer treatment vaccines under development are intended to induce antigen-specific antitumor immune responses. This means that the vaccine induces an immune response against the cancer cells present in the patient. myeloma and leukemia. some vaccines are made from leukemic cells treated in test tubes to convert them to potent antigen-presenting cells. Examples of this treatment are the drugs ibritumomab (Zevalin®) and tositumomab and iodine I131 tositumomab (Bexxar®). 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 basis for the vaccine is to make the cancer cells susceptible to immune attack by heightening the recognition of markers on the cancer cells. is approved for older patients with AML who relapse after initial treatment. In studies of CML. DNA vaccines that contain the DNA that encodes the specific antigen are being tested. 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. These types of vaccines would be used in patients who have small amounts of residual blood cancer after chemotherapy or stem cell transplantation. gene therapy researchers are trying to modify an oncogene (BCR-ABL) that produces a protein that stimulates malignant cell growth.
Leukemia is divided into four categories: myelogenous or lymphocytic.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. a deficiency of red cells. Leukemia is expected to strike more than 10 times as many adults as children in 2007. It is characterized by the uncontrolled accumulation of blood cells. Epidemiology. • The most common form of leukemia in children is acute lymphocytic leukemia (ALL).240 new cases of leukemia will be diagnosed in the United States this year. • Most cases of leukemia occur in older adults.790). Chronic leukemia progresses more slowly and allows greater numbers of more mature. males are expected to account for 56 percent of the new cases of leukemia.410 4. • About 33 percent of cancers in children aged 0-14 years are leukemia • Most cases of chronic myelogenous leukemia (CML) occur in adults. The terms myelogenous or lymphocytic denote the cell type involved. Surveillance Research Program.000 population. Nearly 54 percent of the new cases of this disease will occur among children in 2007 (about 2. 2007. 2004 Type Chronic lymphocytic leukemia Chronic myelogenous leukemia Acute lymphocytic leukemia Acute myelogenous leukemia Prevalence* 95. more than half of all cases occur after age 67. American Cancer Society.240 Male 3.140 6.340 13. and End Results) Cancer Statistics Review 1975-2004. each of which can be acute or chronic.501 50. NCI.4 percent of leukemias in children aged 0-19 are CML. The incidence rates are usually presented as a specific number per 100. *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.570 3.800 Female 2. functionless cells in the marrow and blood. released April 2007. Anemia. and SEER Program. red blood cells and white blood cells. functional cells to be made. Acute leukemia is a rapidly progressing disease that results in the accumulation of immature.380 6. Chronic leukemias account for 7 percent more of the cases than acute leukemias.960 7.000 2. A shortage of platelets results in bruising and easy bleeding.) • The most common types of leukemia in adults are acute myelogenous leukemia (AML) and chronic lymphocytic leukemia (CLL).150 24. develops in virtually all leukemia patients. Estimated 29-Year L-D Prevalence Counts on 1/1/2004 by Duration. Prevalence database: U.S. based on the November 2006 SEER data submission.350 2.S. Table 3: Source: Cancer Facts & Figures 2007.200 15. *Note: Incidence rates are the number of new cases in a given year not counting the preexisting cases.440 adults compared with 3.189 27. aged 0-19. Approximate U. The lack of normal white cells impairs the body’s ability to fight infections. Incidence by Gender Incidence rates* for all types of leukemia are higher among males than among females.060 2.659 people in the United States are living with leukemia. The marrow often no longer produces enough normal platelets. In 2007.060 8. The four major types of leukemia are shown in Table 1. 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. National Cancer Institute.720 44.Leukemia Leukemia is a malignant disease (cancer) of the bone marrow and blood.570 19. Statistical Research and Applications Branch. Prevalence of the Four Major Leukemias as of Jan.579 21.570 5. DCCPS. New Cases An estimated 44. LEUKEMIA page 6 LYMPHOMA MYELOMA . Only 2.440 Table 2: Sources: SEER (Surveillance. 2007. (About 40.800 children.
Estimated Proportion of New Cases (%) in 2007 for Each Type of Leukemia Including Adults and Children 3. Some people with chronic leukemia may not have major symptoms and are diagnosed during a medical examination. 2007. About 2. 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. The incidence of ALL among 1. eighth and ninth decades of life. These cancers are most prevalent in the seventh.to 29-year olds. Most children under 15 years of age with ALL are cured. CML incidence also increases dramatically among people who are aged 60 and older. The most common form of leukemia among children under 20 years of age is ALL.619 with ALL. Leukemia is one of the top 15 most frequently occurring cancers in minority groups.to 4-year-old children is more than nine times greater than the rate for young adults ages 20 to 24. Possible Causes of Leukemia Anyone can get leukemia.799 children under the age of 20 diagnosed with leukemia from 2001-2004.to 19-year olds. including the examination of the cells in blood or marrow. the incidence of AML slowly rose while that of ALL steadily decreased in the period from late adolescence to older adulthood. averaging about 189. American Cancer Society.790 new cases of childhood ALL are expected to occur in 2007.800 children will be diagnosed with leukemia throughout the United States.900 new cases of cancer diagnosed in African-Americans in 2007. These signs are not specific to leukemia and may be caused by other disorders. CLL incidence increases dramatically among people who are aged 50 and older. The American Cancer Society estimates that there will be approximately 152. neither explains most cases.5 times that of ALL. Adolescents and Young Adults. Incidence by Age-Group Incidence rates by age differ for each of the leukemias. and AML incidence increases dramatically in people who are aged 60 and older. LEUKEMIA LYMPHOMA MYELOMA page 7 .922 cases per year. Children. Leukemia incidence is highest among whites and lowest among American Indians/Alaskan natives. Leukemia rates are substantially higher for Hispanic. ALL incidence was approximately twice that of AML. white and Asian/Pacific islander children than for black children. 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). Although chronic exposure to benzene in the workplace and exposure to extraordinary doses of irradiation can be causes of the disease. The diagnosis of leukemia requires specific blood tests. American Indian/Alaskan natives. 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. From 1975 to 2000. Adults. Among 15. was 504 per 100. They do warrant medical evaluation. Leukemia strikes all ages and both sexes. from 2000-2004. The leukemias represented 27 percent of all cancers occurring among children younger than 20 years from 2000-2004. including 3. In 25. However. leukemia rates are higher in Americans of European descent than among those of African descent. AML incidence was approximately 1. The incidence rate for all cancers among AfricanAmericans in the Seer (17 region). Hispanic children of all races under the age of 20 have the highest rates of leukemia. In the 17 SEER regions of the United States. The cause of leukemia is not known.000 population. It is estimated that in 2007. Figure 3: Source: Cancer Facts & Figures 2007. there were 4.
For acute leukemia. During 1996-2003. In 1960-1963. the five-year relative survival rates overall were: • ALL: 65. LEUKEMIA page 8 LYMPHOMA MYELOMA . By 1975-1977. Complete remission means that there is no evidence of the disease and the patient returns to good health with normal blood and marrow cells.3 percent overall. a patient had a 14 percent chance of living five years. The relative survival rates differ by age of the patient at diagnosis. Treatment centers report increasing numbers of patients with leukemia who are in complete remission at least five years after diagnosis of their disease.9 25-29 1. 2000-2004 25 23. National Cancer Institute. when compared to a person without leukemia. 90.7 percent overall.2 23 21 19 19. National Cancer Institute.2 10.000) 17 15. race and type of leukemia.6 2.4 5-9 0. and in 1996-2003.6 10-14 0.5 21. gender.4 percent for children under 5 • CLL: 74. 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 1975-2004.7 7 5 3 1 0 1.9 20-24 0. a complete remission (no evidence of disease in the blood or marrow) that lasts five years after treatment often indicates cure. Treatment of Leukemia The aim of treatment is to bring about a complete remission.3 1. The five-year relative survival rate has more than tripled in the past 47 years for patients with leukemia.2 1. 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.Age-Specific Incidence Rates for Acute Myelogenous Leukemia (All Races).1 Incidence (per 100.1 4.4 percent Five-Year Relative Survival Rates for All Ages.1 for children under 15 • CML: 44. All Types Leukemia. 54. the five-year relative survival rate had jumped to 35 percent. Epidemiology and End Results) Cancer Statistics Review 1975-2004.8 percent • AML: 20.4 <1 0. the overall relative survival rate was nearly 50 percent.8 1-4 0. Relapse indicates return of the cancer cells and the return of other signs and symptoms of the disease.9 15-19 0. 2007. 2007.8 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. Thirty-two percent more males than females are living with leukemia.3 3.2 15 13 11 9 7.
in Children Under 15 Years of Age. National Cancer Institute. Sources: 1.320 Female 600 1. 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.970 250 2.790 deaths in the United States will be attributed to leukemia in 2007: 12. In 2007. LEUKEMIA LYMPHOMA MYELOMA page 9 .470 Table 4: Source: Cancer Facts & Figures 2007. American Cancer Society.990 deaths from AML and 490 deaths from CML. 1964:24:477-494. Despite this decline. 2007.Five-Year Relative Survival Rates for Acute Lymphocytic Leukemia.500 deaths from CLL and 1.470 females. There will be an estimated 8.390 additional deaths.680 12.710 9. 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. Cancer Statistics Review.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. Zuelzer WW. 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. Implications of long-term survivals in acute stem cell leukemia of childhood treated with composite cyclic therapy. leukemia causes more deaths than any other cancer among children and young adults under age 20. African-Americans who were diagnosed with leukemia between the ages of 25 and 44 had the highest death rates from the disease during this period.390 21. Non-Hispanic whites diagnosed with leukemia over the age of 44 had the highest death rates during this period.420 deaths from ALL. There will be an estimated 4. 2007.790 Male 820 2.020 240 3. deaths from leukemia are expected to be distributed in the following numbers: In 2007. 2. about 515 children under the age of 14 are expected to die from leukemia. Blood. Hispanics with leukemia who are under the age of 25 had the highest mortality rates from the disease between 1990 and 1999.500 8.560 5. Deaths It is anticipated that approximately 21. Epidemiology and End Results).940 3. In 2007.990 490 6. Unclassified forms of leukemia will account for 6. SEER (Surveillance. unclassified forms of leukemia Total Overall 1. leukemia will be the fifth most common cause of cancer deaths in men and the sixth most common in women.420 4. 1975-2004.
rose by 84 percent from 1975 to 2004. The reasons for the development of non-Hodgkin lymphoma are not certain. These risk factors explain only a small proportion of cases. LEUKEMIA page 10 LYMPHOMA MYELOMA . After 50 to 54 years of age. By ages 60 to 64.8 percent.200 38. 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. Immune suppression plays a role in some patients. eventually crowding out healthy cells and creating tumors that enlarge the lymph nodes or other sites in the body. incidence rates for non. intermediate and high grade.9 per 100. 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. while 0. The Epstein-Barr virus causes Burkitt’s lymphoma in Africa.313 people living with Hodgkin lymphoma (active disease or in remission) and 405. they are 52. The groups are often classified as indolent or aggressive. Age-specific incidence rates of non-Hodgkin lymphoma are 2. and each has prognostic factors that categorize it as more or less favorable. Both Hodgkin and non-Hodgkin lymphomas are more common in males than in females. The bacterium Helicobacter pylori is associated with the development of lymphoma in the stomach wall. New Cases of Lymphoma by Gender.9 per 100. American Cancer Society. Incidence rates for Hodgkin lymphoma tend to be higher among males than among females. there are 138. 2007. 2007 Type Hodgkin lymphoma Non-Hodgkin lymphoma Total Male 4. Persons infected with the human immunodeficiency virus (HIV) have a much higher risk of developing lymphoma.266 members of the U. New Cases About 71.000 at ages 20 to 24 for males and 1.7 percent of all cases of non-Hodgkin lymphoma will be diagnosed in children under 15 years of age this year.990 32.720 28.190 63. the difference was small. Fifty-three percent of the blood cancers diagnosed are lymphomas.000 for females. Lymphoma results when a lymphocyte (a type of white blood cell) undergoes a malignant change and begins to multiply. In 2004.000 for females.380 Americans will be diagnosed with lymphoma in 2007 (8.953 people living with nonHodgkin lymphoma for a total of 544.380 Table 5: Source: Cancer Facts & Figures 2007.3 per 100. Living with Lymphoma In the United States in 2007.190 71. population who are living with lymphoma. More than four percent of all cases of Hodgkin lymphoma diagnosed in 2007 will be in children under 15 years of age.190 cases of Hodgkin lymphoma and 63. Non-Hodgkin lymphoma is the fifth most common cancer in males and females in the United States. Hodgkin Lymphoma Hodgkin lymphoma is a specialized form of lymphoma and will represent about 11.000 for males and 38.710 Total 8.Lymphoma Lymphoma is a general term for a group of cancers that originates in the lymphatic system.6 per 100.470 34.5 percent of all lymphomas diagnosed in 2007. Each histologic grouping is diagnosed and treated differently. including the presence of an abnormal cell called the ReedSternberg cell (a large. malignant cell found in Hodgkin lymphoma tissues).670 Female 3. or low. 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.190 cases of non-Hodgkin lymphoma).S. It is the sixth most common cause of cancer deaths in males and in females. Incidence by Gender Table 5 illustrates the breakdown of incidence of lymphoma by gender.Hodgkin lymphoma are higher in Americans of European descent than among those of African descent. in general whites have higher incidence rates than blacks. an average annual percentage increase of 2.
widespread disease requires chemotherapy or chemotherapy and/or monoclonal antibody therapy with radiation.400 children under the age of 15 will be diagnosed with cancer in 2007.to 24year-old individuals. loss of appetite and bone pain. Adolescents are more commonly diagnosed with Hodgkin lymphoma than young children.660 from non-Hodgkin lymphoma.5 percent. Treatment for non-Hodgkin lymphoma sometimes includes vaccines and other forms of immunotherapy. In children from 0 to 19 years of age. armpit or groin. cell type and location of the lymphoma. most children with nonHodgkin lymphoma did not live five years after diagnosis.1 per 100. Survival for Adults Hodgkin lymphoma is now considered to be one of the most curable forms of cancer.1 cases per 100. persistent fatigue.9 percent). sweating at night. Incidence in Children The incidence of Hodgkin lymphoma among people under 20 years of age was 1.2 percent for Hodgkin lymphoma in people under 20 years of age.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. followed closely by Hispanic children of all races (24.5 percent. and more than 46-fold to 112. Death rates have been declining for Hodgkin lymphoma patients since the mid-1970s. About 2. Lymphomas (Hodgkin lymphoma. depending on the tumor size. Hispanics of all races have the second highest incidence rates of non-Hodgkin lymphoma after whites. Early stage. Non-Hodgkin lymphoma is the fifth most common cancer in Hispanics. Five-year relative survival is now 95 percent for Hodgkin lymphoma in children aged 0 to 14 years. lymphomas are most commonly diagnosed in whites (24. following leukemia (26. Radiation.8 percent) and neoplasms of the brain and other nervous tissue (17. indigestion and abdominal pain. 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. In the United States. the highest incidence of non-Hodgkin lymphoma is in Asian/Pacific islanders. five-year relative survival for non-Hodgkin lymphoma is now 83. Treatment Hodgkin lymphoma is often treated with radiation and chemotherapy. It has remained fairly constant since 1999. and is the eighth most common cause of cancer death in that group. 4. excessive tiredness. In children under 20 years of age. The most common early sign of other forms of lymphoma is also painless swelling of the lymph nodes – usually in the neck.000 persons at ages 80 to 84. LEUKEMIA LYMPHOMA MYELOMA page 11 . Survival for Children Five-year relative survival is 95. Non-Hodgkin lymphoma is the ninth most common cause of cancer death in males and the seventh in females in the United States. armpit. Incidence in Adults The incidence of non-Hodgkin lymphoma increases with age.8 percent for all races in 1996-2003.4 cases per 100. The rate increases more than 18 times to 45. Symptoms also often include fever. It is rarest among American Indian/ Alaskan native children. The five-year relative survival rate for non-Hodgkin lymphoma patients has risen from 31 percent in whites in 1960-1963 to 63.000 people occur in 20.0/1 million population).000 children in 2004. From ages 15 to 19. In children up to age 14 years. Signs and Symptoms Signs and symptoms of Hodgkin lymphoma include painless swelling of lymph nodes in the neck. and non-Hodgkin lymphoma.070 from Hodgkin lymphoma). night sweats. recurrent high fever. localized non-Hodgkin lymphoma is sometimes treated with radiation. troublesome itching and weight loss.5/1 million population). 3. the highest incidence of non-Hodgkin lymphoma is in non-Hispanic whites.000 by ages 60 to 64. Deaths An estimated 19. 1. about 10. The incidence in this group decreased almost steadily and significantly between 1975 and 1999. Even in the mid-1970s.Among women. comprising nearly 5 percent of all cancers diagnosed. groin or in the abdomen.1 cases per 100.730 persons will die from lymphoma in the United States in 2007 (18. This represents a significant improvement in the rate of recovery.
9 3.Age-Specific Incidence Rates for Hodgkin Lymphoma.8 4.3 <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.2 4.1 4.360 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 2007.070 18.5 <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. 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 1.4 80.9 4.2 1.5 10.8 112.730 Male 770 9. 2007.4 15. American Cancer Society.3 4.600 10. National Cancer Institute. 2000-2004 6 Incidence (per 100. *<16 cases per time interval.4 3.1 0. 2007.0 45.4 4.000) 5 4 3 2 1 0 0.6 32.060 9.8 3. Epidemiology and End Results) Cancer Statistics Review 1975-2004. Age-Specific Incidence Rates for Non-Hodgkin Lymphoma. LEUKEMIA page 12 LYMPHOMA MYELOMA .1 0.0 2.370 Female 300 9.4 2.000) 70 60 50 40 30 22. 2007.4 2. Table 6: Source: SEER (Surveillance.660 19. * <16 cases for time interval.9 1.0 3. 2000-2004 110 100 90 80 Incidence (per 100.1 3.4 2. Epidemiology and End Results) Cancer Statistics Review 1975-2004.0 1. National Cancer Institute.1 102.6 0.1 3.4 2.1 63.8 2. Epidemiology and End Results) Cancer Statistics Review 1975-2004.9 7. 2007.0 20 10 0 0.0 0. National Cancer Institute.0 100.
a type of white blood cell found in many tissues of the body. 2000-2004 Incidence (per 100.1 21. Living with Myeloma An estimated 60. Treatment Chemotherapy for myeloma has led to sustained remissions in some patients. Treatment may include intensive chemotherapy followed by stem cell transplantation to restore normal blood cell production. Fractures may occur as a result of the weakened bones. has been increasing.7 1. destroying normal bone tissue.1 0. The U. It is 71 for African-Americans.4 33.960 men and 8.1 Signs and Symptoms Often the first symptom of myeloma is bone pain caused by the effects of myeloma cells in the marrow.000).S. Figure 9: Source: SEER (Surveillance.2/100. but primarily in the bone marrow.000). Usually. 5-9. SEER 17 areas (<1. National Cancer Institute. Recurrent infections may be an early sign of the disease. 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. the patient’s own stem cells are used (autologous stem cell infusion). New Cases An estimated 19. Survival Current statistical databases show that overall five-year relative survival in patients with myeloma has shown a significant improvement since the 1960s: 12 percent in 1960-1963 for whites to 34 percent from 1996-2003 for all races. a B lymphocyte. • The median age at diagnosis is 70. LEUKEMIA LYMPHOMA MYELOMA page 13 . The mortality rate from myeloma for people of African descent is more than double the rate for whites (7.1 28. the cell that forms plasma cells. *<16 cases for each age interval. median age at death from multiple myeloma is 74. 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 highest rates are found in black men 80 to 84 years of age and older (105/100. two or three drugs are used simultaneously.3 0. (11.940 women) new cases of myeloma will be diagnosed in the United States in 2007. The onset of myeloma interferes with normal production of antibodies and makes myeloma patients susceptible to infections. myeloma was the 10th most commonly diagnosed cancer among African-American men and women.5/100. It grows continuously and forms masses of plasma cells. and it rarely occurs in people under age 45.1 5. • The incidence rate in men (7/100. becomes malignant. Approximately 3 percent of all cancer-related deaths among AfricanAmericans in 2000-2004 were from myeloma.9 9.000). Total survival for white males. Lenalidomide is approved by the FDA in combination with dexamethasone for the treatment of myeloma patients who have received at least one prior therapy. Patients may have anemia. 10-14.000) is 56 percent higher than for women (4.5 3. approximately double.Myeloma Myeloma is a cancer of the plasma cells. tire more easily and feel weak.0 37.8 14.5/100. • The median age at diagnosis for African-Americans is 67. Age-Specific Incidence Rates for Myeloma.3/100. Treatment is aimed at slowing progress of the disease. Deaths Approximately 10. 1-4. At times. In myeloma. 2007.000 to 3. 15-19. From 2000 to 2004. Bortezomib has been approved for treating myeloma in patients who have had at least two prior therapies. Malignant plasma cells produce an abnormal protein called monoclonal immunoglobulin.790 deaths from myeloma are anticipated this year. 20-24).424 people in the United States are living with myeloma.900 (10. Sixty percent of those were diagnosed with the disease within the past four years.1/100.000) of myeloma than those of European descent (5.000) 40 30 20 10 0 0-24 0. especially in the marrow. Epidemiology and End Results) Cancer Statistics Review 1975-2004.000) for all racial and ethnic groups. Thalidomide is approved by the FDA for use in treating newly diagnosed myeloma.4 35. especially. • Americans of African descent have a much higher incidence rate. Myeloma was the 10th most common cause of cancer deaths for women in 2000-2004. causing pain and crowding out normal blood cell production. but it is the most difficult blood cancer to treat successfully.
(Based on SEER 17 areas.4 4. 2007. National Cancer Institute.000 Population (2000-2004) Type Leukemia Non-Hodgkin lymphoma Hodgkin lymphoma Myeloma Overall 12.2 6.2 14.0 7.) LEUKEMIA page 14 LYMPHOMA MYELOMA . Epidemiology and End Results) Cancer Statistics Review 1975-2004.2 Male 16. for Whites.Incidence Rates: Leukemia.7 5.5 16.9 5.5 Table 8: Source: SEER (Surveillance.6 4.3 19. Lymphoma and Myeloma The following tables showing incidence rates for leukemia. (Based on SEER 17 areas.4 11. per 100.3 2. for Blacks.1 2. Epidemiology and End Results) Cancer Statistics Review 1975-2004. 2007.2 18.1 11. Rates are per 100.8 20.0 2.1 3.6 Female 9. Hodgkin and non-Hodgkin lymphoma and myeloma use figures from 2000-2004.000 Population (2000-2004) Type Leukemia Non-Hodgkin lymphoma Hodgkin lymphoma Myeloma Overall 10.0 Female 9.1 9.6 2. Epidemiology and End Results) Cancer Statistics Review 1975-2004. Incidence Rates by Gender. National Cancer Institute.9 17.) Table 9: Source: SEER (Surveillance. (Based on SEER 17 areas.8 14. per 100. 2007.0 Female 8. the most recent available.5 Incidence Rates by Gender.3 Male 13.) Incidence Rates by Gender.1 Table 10: Source: SEER (Surveillance.0 23.6 Male 16.000 population and are age-adjusted to the 2000 population.3 2. per 100. National Cancer Institute.9 2.2 3.000 Population (2000-2004) Type Leukemia Non-Hodgkin lymphoma Hodgkin lymphoma Myeloma Overall 12. All Races.2 2.7 24.
S. American Cancer Society.540 1.200 350 4. **State estimates may not add up to U.260 220 400 420 290 2.140 380 140 1.070 80 330 70 480 1.070 110 1.560 770 890 3. by State. is described by Pickle et al.360 960 170 220 2. 2007 State Leukemia Non-Hodgkin Lymphoma Myeloma Hodgkin Lymphoma*** Estimated Deaths from Blood Cancers by Site.550 * * * * *20 * * * * 60 * * * 50 * * * * * * * * * * * * * * * * * * 70 * * 50 * * 60 * * * * 80 * * * * * * * 390 Table 11: Sources: Cancer Facts & Figures 2007.030 570 * 610 210 360 1.080 1.610 670 610 110 60 3. Used with permission. Table 12: Sources: Cancer Facts & Figures 2007. which is new for 2007.170 480 1. by State.300 110 63.300 470 90 100 750 430 300 220 290 310 110 320 420 660 350 170 500 80 110 130 90 600 120 1.140 60 260 80 410 1. Used with permission.Estimated New Cases of Blood Cancers by Site. LEUKEMIA LYMPHOMA MYELOMA page 15 .830 240 230 60 * 1.150 290 270 70 * 1.180 4. *Estimate is fewer than 50 cases.240 170 550 130 800 3.360 610 * 950 290 260 1. The method of derivation.330 260 780 180 1.370 250 280 2. American Cancer Society. 2006.660 210 * 190 120 1.S. 2007 State Leukemia Non-Hodgkin Lymphoma Myeloma Hodgkin Lymphoma Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist.130 300 80 900 960 300 1.500 430 1. 1969-2004.670 1.250 1.630 540 80 120 990 510 310 230 320 330 100 390 490 770 400 210 460 80 150 160 100 680 120 1.530 1. Note: These estimates are offered as a rough guide and should be interpreted with caution.510 500 60 70 900 380 220 160 280 430 100 370 460 730 310 170 400 70 110 120 80 650 120 1.010 1.680 920 340 890 170 290 330 190 1. National Center for Health Statistics.190 290 * 280 200 1. 2007.160 140 50 360 440 170 320 * 18. Numbers are rounded to the nearest 10. model (see below). numbers are small and NCI and ACS are having difficulty fitting them into the Pickle et al. 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 2.080 600 7.790 330 * 320 200 1. and additional data supplied by the American Cancer Society based on data from the U. ***Hodgkin lymphoma estimates are not available for 2007. Mortality Public Use Data Tapes. total because of rounding and exclusion of estimates that are fewer than 50 cases. **State estimates may not add up to U.190 880 870 170 100 4.550 2.030 910 620 420 680 680 250 630 1.710 570 500 2.050 140 140 * * 680 310 * 50 440 240 130 120 170 180 60 220 250 420 190 110 240 50 70 80 50 270 70 650 360 * 460 120 160 550 * 200 * 270 720 70 * 250 220 70 200 * 10.410 130 50 500 490 130 490 * 21.520 310 3. Note: These estimates are offered as a rough guide and should be interpreted with caution.880 240 250 50 50 1..610 150 2.040 70 44. They cannot be compared with previous years’ estimates to determine cancer incidence trends.160 1. total because of rounding and exclusion of estimates that are fewer than 50 cases. CA A Cancer Journal for Clinicians. 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 4.410 560 * 740 230 230 930 70 300 50 350 1. Centers for Disease Control and Prevention.390 1.S.310 800 600 900 920 330 1.070 Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. January/February 2007. *Estimate is fewer than 50 cases. and additional data supplied by the American Cancer Society. 2007.370 100 * 430 380 130 350 * 19. Numbers are rounded to the nearest 10.240 740 80 1.
S. so the exact number of cases is not known.” as per SEER table I-21. Prevalence may be calculated in a number of different ways. LEUKEMIA page 16 LYMPHOMA MYELOMA . Census. race and ethnicity in various regions and region-specific health risks. It considers deaths from all causes. Incidence rates can be calculated based on a number of factors such as age. (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). Thus. Bureau of the Census’ 2000 population data for that region. 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. race or sex. This year. The relative survival rate is a comparison of survival to a person who is free of the disease. In this report. in comparison to the 2002 SEER report. population) that belong to the National Program of Cancer Registries. Thus. Because of this change in method. When expressed as a rate. This change means that the 2007 incidence estimates are not comparable with previous estimates for determining cancer incidence trends. may be incomplete in some cases and the data may reflect adjustments that anticipate changes that will occur once the actual data are received. but these figures do not take into account differences in geography.) Prevalence is the estimated number of people alive on a certain date in a population who previously had a diagnosis of the disease. 2007. 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. mostly upward. estimates of cancer incidence. CA A Cancer Journal for Clinicians.” We are using the “29-year limited duration” prevalence figures.Notes and Definitions Notes The United States does not have a nationwide reporting system or registry for blood cancers. Because of reporting delays from some of the SEER regions. January/February 2007. 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 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. 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. 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. state-by-state data for incidence of Hodgkin lymphoma are not available because these numbers are so small. in some cases fewer than 17 SEER regions) and death data from the National Center for Health Statistics. only the first diagnosed cancer counts. the American Cancer Society changed its method of estimating cancer incidence. In some prevalence statistics. Epidemiology and End Results Program (SEER) regions (or. prevalence numbers reported may vary depending upon the method used to determine them.S. no matter how long ago that diagnosis was. survival and mortality have been revised. his or her survival with leukemia may not be counted in leukemia prevalence statistics. cancer or otherwise. population. Relative survival rate is an estimate of the percentage of patients who would be expected to survive the effects of the cancer.S. the data presented in the 2007 SEER report placed online on April 15. The SEER (17 region) data cover only about 26 percent of the U. Because of changes in the information — such as racial classification — gathered in the 2000 U. The data can be extrapolated for the entire United States by multiplying by the population ratio. The data presented in this report are an extrapolation or estimate of the number of cases reported by the 17 Surveillance. if a person is initially diagnosed with melanoma and later develops leukemia. The specified date is 1/1/2004 for the prevalence estimates. The description of the methods used was published in Pickle et al. it is the number of new cases per standard unit of population during the time period. Definitions Incidence is the number of newly diagnosed cases for a specific cancer or for all cancers combined during a specific time period. It includes new (incidence) and preexisting cases and is a function of both past incidence and survival.S.. especially in looking at populations in which individuals have had more than one type of cancer.
Ries LAG (eds). 25-38. Jemal A. NIH Pub. pp. and End Results) Cancer Statistics Review. Clegg L. MD. Feuer EJ. January/February.” Mattano L Jr. “Cancer Statistics. Howlander N. Hachey M. 2007.Citations Source Citations Cancer Facts & Figures 2007. In Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age. Tiwari RC. The Oncologist Vol. Mariotto A. Bethesda. “Leukemias. Cancer Facts & Figures for African Americans 2007-2008. pp. Krapcho M. “Highlights and Challenges. 174. Atlanta: American Cancer Society. Eisner MP. Bethesda. Barr R. Epidemiology. 06-5767.” Bleyer A. 2006. http://www. Atlanta: American Cancer Society. Nachman J. Barr R.org/cgi/content/full/57/1/30. 2006. National Cancer Institute. In Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age. Ross J. Bleyer A. Ward E. Cheson B. Barr R. “A New Method of Estimating United States and State-Level Cancer Incidence Counts for the Current Calendar Year. 2007. Shu X-O. CA A Cancer Journal for Clinicians Vol. O’Leary M. Barr R. p.amcancersoc.cancer. http://caonline. 2007. Epidemiology. Reichman ME.gov/csr/1975_2004/ LEUKEMIA LYMPHOMA MYELOMA page 17 . 20-37. No. 065767. NIH Pub. 2006. Feuer EJ.” Hayat MJ. Reichman M. 2007. Ries LAG (eds).” Pickle LW. SEER (Surveillance. MD. Bleyer A. In Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age. Howe HL. and End Results (SEER) Program. 1975-2004. pp. posted to the SEER Web site 2007. Bleyer A. Including SEER Incidence and Survival: 1975-2000. 39-51. Bethesda. National Cancer Institute. Keller F.com/cgi/content/full/12/1/20. Including SEER Incidence and Survival: 1975-2000. 30-42. http://seer. based on November 2006 SEER data submission. Edwards BK.” O’Leary M. Sheaffer J. Ries LAG (eds). Miller BA. No. 57. NIH Pub. O’Leary M. Ries LAG. Trends. and Multiple Primary Cancer Analyses from the Surveillance. January. Melbert D. 065767. No.TheOncologist. pp. O’Leary M. 12. Including SEER Incidence and Survival: 1975-2000. Horner MJ. Edwards BK (eds). Stock W. National Cancer Institute. Hao Y. “Lymphomas and Reticuloendothelial Neoplasms. National Cancer Institute. Howlader N. MD. MD. Zou Z. Bethesda.
They are: 1) Career Development Program (CDP)-basic research. Research Research Grant Programs The Society’s research programs are based on the belief that all scientifically sound approaches toward a cure for. lymphoma and myeloma research comprise four review subcomittees. The Society is a nonprofit organization that relies on the generosity of individual and corporate contributions to advance its mission. lymphoma. each focused on the discovery of new approaches to benefit patients or those at risk for developing leukemia. Translational Research • Scholars in Clinical Research are awarded $110. Translational Research Program The Translational Research Program provides early-stage support for research on leukemia. research reaching a clinical trial can receive $1 million over five years to facilitate new drug discovery or advances in diagnosis or prevention. Now supporting $61. • Special Fellows are awarded $60. The program is expected to generate new knowledge and breakthrough discoveries. Translational Research and the Specialized Center of Research (SCOR). • Special Fellows in Clinical Research are awarded $60. The Grant Review Process Scientists and physician-scientists who are experts in the field of leukemia. lymphoma and myeloma that is intended to advance treatment. are granted each year. and improve the quality of life of patients and their families. The participating scientists may be at different institutions or from any country. We offer a wide variety of programs and services in support of our mission: Cure leukemia.000 a year for a total of $150. to a total cost of $6.25 million per year over a five-year period. the Society’s grant programs are among the most prestigious in the fields of blood cancers. Awards go to those groups that best demonstrate the synergy that will occur from their close interaction. lymphoma or myeloma.000 a year for a total of $180. leukemia. the Society has awarded more than $550 million in research grants.000.000 over three years.000 a year for a total of $550. Each SCOR is funded up to $1. 3) Translational Research Program.000 over five years.000 a year for a total of $180.25 million. Awards up to $200.000 over five years. Funding for two additional years may be provided for highly promising projects that are entering phase I clinical trial. 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. for a total of $600. Thus. 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. diagnosis or prevention in the near term. The Specialized Center of Research (SCOR) in Leukemia.000 per year for three years.6 million annually on research. Since the first funding in 1954.000 over three years.000 a year for a total of $550. or control of. lymphoma and myeloma. leading to better survival rates and prevention measures for patients. Research grants are awarded in three program areas: Career Development. treatment or prevention of leukemia.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. Translational Research Awards are made for an initial three-year period. The SCOR program brings together research teams working in complementary areas. • Fellows are awarded $50. 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 .000 over three years. Career Development Program The Career Development Program supports promising young scientists (Scholars. lymphoma and myeloma should be encouraged worldwide. The SCOR grants also support scientific core laboratories to provide access to innovative technology if required by the participating research programs. Hodgkin’s disease and myeloma. 2) CDP-clinical research.
This support should advance the understanding. lymphoma and myeloma.LLS.org/copay. clinical trials and offer guidance on coping. including support groups. serves a wide variety of education and information needs. to 6 p. 2007 the Society will have 379 active grantees at 116 institutions in the United States and abroad.org. As of June 30. podcasts and Webcast archives of these programs are available at www.org or faxing to (914) 949-6691 or contacting the Research Department at (914) 949-5213.org.important projects to advance the Society’s mission. friends and healthcare professionals.m.org or by or emailing researchprograms@LLS. brochures and videos through the IRC and local Society chapters. ET. The site features a comprehensive overview of blood cancers.LLS. the Translational Research Grant Progress Review Meeting and the SCOR Progress Review Meeting.org. Each year. The Society funds several Focused Workshops each year on important topics relevant to hematological malignancies. They are available to talk one-onone. myelodysplastic syndromes (MDS) and other blood cancers. Information on registration for these free events can be accessed at www. The Annual Research Symposium. Much of the content of these materials is available to view and download at www.m.org. treatment and prevention of leukemia. their families and healthcare professionals. The user has the opportunity to create personalized pages with identified interests. Educational Materials An extensive collection of free educational materials are offered to patients and health professionals. and click “Live Help. Other meetings are held for the Society’s grantees.LLS. You may also chat online with an information specialist.LLS. and applications for the Society’s three research programs may be obtained by visiting www.LLS. www. myeloma. ET. Monday through Friday. Co-Pay Assistance Program Patients with AML. Patients. www. Guidelines.org. lymphoma. Information specialists are oncology social workers and health educators who provide callers with current information on blood cancers.m. treatments. where medical professionals share the latest research findings. LEUKEMIA LYMPHOMA MYELOMA page 19 . Teleconferences and Webcasts The Society sponsors more than 25 educational teleconferences and Webcasts each year on topics of interest to patients and caregivers. These include the Stohlman Scholar Symposium. instructions. The IRC is a worldwide link to information and resources useful to patients. It is continually being updated and expanded to support and promote the Society’s mission.” Chapter Programs: Family Support Groups: The Society has developed more than 360 Family Support Groups at 68 chapters.org. Family Support Group locations. audio. information about our peer-to-peer program First Connection and other programs. Patients needing assistance may apply on the Society’s Web site.org. sponsored by the Society. First Connection: This program links newly diagnosed patients to a peer volunteer who has experienced a similar diagnosis. Guided by two volunteer oncology health professionals. www.LLS. from 10:00 a. on the Society’s Web site. families and professionals may call the IRC toll free at (800) 955-4572 in addition to corresponding by email at infocenter@LLS. families. each group provides information and support. the Society’s programs and services. lymphoma. 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. A trained patient volunteer currently in remission phones the new patient to share information and support. and encourages greater communication among patients.m.LLS. is held each December on the Friday immediately before the American Society of Hematology meeting. 9 a. Professional Education The Society serves the continuing educational needs of the medical and research community through professional symposia offered throughout the year. The Society also hosts numerous teleconferences and Webcasts. The Society’s Web Site The Society’s Web site. The educational program offers varying formats to facilitate the exchange of information and ideas on the newest developments in cancer research and treatment. the Society distributes more than 1 million booklets. Patient Services The Society has a network of 68 chapters throughout the United States and Canada. to 5:00 p. Information Resource Center (IRC) The Society strives to be the world’s foremost source of information on leukemia. These offices conduct lifeenhancing patient services. peer counseling and patient financial aid. call (877) LLS-COPAY ( 557-2672) or email copay@LLS.
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. Meet the Expert on Non-Hodgkin Lymphoma: This program presents basic information on terminology. Advocacy Since 1994. Patient financial aid funds are subject to availability. The Trish Greene Back to School Program for Children with Cancer: This program is designed to increase communication among healthcare professionals. providing additional support for blood cancer patients and their families nationwide. how cancer drugs are developed and what the emerging treatment options are for leukemia. 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. treatments and future directions for NHL are also discussed. emerging therapies and side effects and addresses the unique challenges of nursing management of these patients. 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. 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. This program is being sponsored by an unrestricted education grant from Novartis Oncology. On the state level. Through the Patient Financial Aid Program. Welcome Back: Facilitating the Return to School for Children with Cancer: A new addition to The Trish Greene Back to School Program. Working through chapters across the country. The Society has identified key issues that currently shape its advocacy agenda. this education program discusses possible emotional and cognitive short. In 2001. representing to policy makers at all levels of government the healthcare quality concerns and medical research interests of patients and their families. and offers numerous resources that can assist childhood cancer survivors to flourish in the school environment posttreatment. staging and classification of nonHodgkin lymphoma (NHL). New Directions in Myeloma Therapy: This program presents an overview of myeloma. That network now numbers more than 35. 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. This program is made possible by the Lance Armstrong Foundation. This program is provided through an unrestricted educational grant from Millennium Pharmaceuticals. This nursing education program provides an overview of CML. 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. LEUKEMIA page 20 LYMPHOMA MYELOMA . diagnosis. New insights. Department of Defense’s medical research program. 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.and long-term effects that children may experience after treatment. 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. unrestricted educational grant from Genentech BioOncology and Biogen Idec Inc. emerging therapies and managing side effects and how to find emotional support when living with the illness. In 2002. It is supported by Amgen Oncology. To date.S.000 and has become a potent voice in public policy deliberations. Printed literature. CML Issues and Insights: A Nursing Education Program on Chronic Myelogenous Leukemia. the Society successfully lobbied Congress to institute a blood cancer research initiative as part of the U.LLS. The patient education program was funded at $18 million through 2007. risk factors. DC. parents. lymphoma and myeloma. that program has funded some $30 million in additional blood cancer research. treatments. reimbursement of up to $500 per year helps cover the costs of transportation. drugs and various treatments not covered by insurance.org and is being sponsored by a generous. This program is also accessible as a Webcast at www. videos and other materials to aid the process are available through all local chapters. treatments. The Path to Progress: Clinical Trials in Blood Cancers: This program provides patients. families and healthcare professionals with a clear description of what clinical trials are.
and Rebecca Siegel. NCI.. .cancer.seer. with the understanding that the Society is not engaged in rendering medical or other professional services. Ph.gov.D. provided ACS’s state-by-state statistics on myeloma and Hodgkin lymphoma. It is distributed as a public service by The Leukemia & Lymphoma Society Inc. for compilation of data for this publication.Acknowledgements Additional data from SEER*Stat Databases at http://www. The Leukemia & Lymphoma Society extends special thanks to Myrna Watanabe. provided statistical assistance. of the American Cancer Society (ACS). This publication is designed to provide information in regard to the subject matter covered. Milton Eisner of SEER.
LLS. and improve the quality of life of patients and their families.LLS Information Resource Center (IRC): 800. lymphoma.HELP. The Society is a nonprofit organization that relies on the generosity of individual. PS80 35M 6/07 .955.org Our mission: Cure leukemia. corporate and foundation contributions to advance its mission. Hodgkin’s disease and myeloma.Home Office 1311 Mamaroneck Avenue. New York 10605 Tel: 888. Suite 310 White Plains.4572 www.
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