The changing profile of Ph-positive chronic myeloid leukemia at presentation: possible impact of earlier diagnosis on survival

Abstract

BACKGROUND AND OBJECTIVE: Although there are indications that the profile of chronic myeloid leukemia (CML) at presentation has changed in recent years, information is scarce. The objective of the present study was to ascertain whether the initial features of CML have changed over time, as well as the possible impact on survival. DESIGN AND METHODS: The initial features of 167 patients diagnosed with chronic phase Ph-positive CML from 1972 to 1985 were compared with those of 174 such patients diagnosed at the same institution from 1985 to 1998. The survival of the two groups was also compared. RESULTS: CML patients diagnosed since 1985 were significantly older at presentation (mean age 47+17 vs 43+17 years, p = 0.04), were more often asymptomatic (36% vs 19%, p = 0.0003), less often had constitutional symptoms (30% vs 45%, p = 0.004), less frequently had splenomegaly (59% vs 75%, p = 0.0008) and hepatomegaly (35% vs 49%, p = 0.01), had less marked leukocytosis (mean WBC count 139+/-124x10(9)/L vs 179+/-132x10(9)/L, p = 0.007), with 30% of them showing an initial WBC count below 50x10(9)/L (vs 19%, p = 0.02), and showed less marrow blast cell infiltration (p = 0.0003). No significant differences were observed in the distribution by Sokal's risk groups. Median survival of patients diagnosed since 1985 was 5. 33 years (95% CI: 4.3-6.36), vs 4.06 years (95% CI: 3.28-4.84) for patients diagnosed before (p = 0.07). Finally, patients asymptomatic at diagnosis had a longer survival (median survival 5.7 years, 95% CI: 4.5-6.9, vs 4.1 years, 95% CI: 3.4-4.7, p = 0.03). INTERPRETATION AND CONCLUSIONS: A substantial proportion of CML patients are currently diagnosed early in the course of the disease. The effect of earlier diagnosis on survival prolongation in such patients should be taken into account.