Epidemiology in B-Cell Malignancies

July 9, 2014
Volume 1, Issue 1

B-cell malignancies include non-Hodgkin lymphomas (NHL) and chronic lymphocytic leukemia (CLL). NHLs are a heterogeneous group of more than 30 cancers of B lymphocytes and T lymphocytes.

1

Demographics

In the United States, B-cell lymphomas comprise about 85% of all NHL. Regarding these B-cell lymphomas, diffuse large B-cell lymphoma (DLBCL) has the highest incidence of 30%, followed by follicular lymphoma (20%).2More than 70, 000 new cases and almost 19,000 deaths are expected as a result of NHL in 2014.3An estimated 15,720 new cases of CLL and 4600 deaths are expected in 2014.4NHL and leukemia are the seventh and eleventh commonest neoplasms, respectively, in the US, with CLL accounting for about one third of leukemia cases.3-5

  • Overall, B-cell NHL and CLL occur in older adults
  • Median age at diagnosis is 66 years for NHL and 72 years for CLL, which is rarely diagnosed in individuals under 40 years of age3,4
  • Generally, incidence is higher in men and Caucasians3,6

Risk Factors6,7

Common general risk factors for B-cell NHL and CLL are:

  • Most patients >60 years of age
  • More common in men
  • Rare in Asian populations, most found in Caucasians in North America and Europe
  • Chemical and radiation exposure may be causes, but more evidence is needed

Differences in risk factors:

  • Immunosuppressed transplant patients are at risk for NHL
  • Rheumatoid arthritis and systemic lupus erythematosus are associated with higher rates of NHL
  • Infections
    • Hepatitis C virus (HCV) is frequently associated with DLBCL and marginal zone lymphoma.8Infection with human immunodeficiency virus (HIV) is also associated with the development of NHL, while Epstein-Barr virus (EBV) is associated with DLBCL and other lymphomas9
    • Helicobacter pyloriare thought to cause mucosa-associated lymphoid tissue lymphoma (MALT) in the stomach
  • Diet may play a role in NHL
  • The risk of developing CLL is not thought to be influenced by infections, smoking, or diet
  • First-degree relatives of patients with CLL have better than twice the risk of developing CLL

Survival

  • Overall 5-year relative survival for patients with NHL is 69.3%, with a median age at death of 76 years3
  • 5-year relative survival is influenced by stage at diagnosis3
    • 28% NHL are localized, with a 5-year survival of 81.6%
    • 49% NHL are distant, with a 5-year relative survival of 61.6%
  • Specific 5-year survival rates (all races, both sexes, all ages)10:
    • DLBCL—60.4%
    • DLBCL (not otherwise specified)—60.3%
    • Follicular lymphoma — 86.1%; 1 in 3 cases transitions to a more aggressive B-cell lymphoma2
  • 5-year survival for CLL is 79%, and also varies with stage4

Characteristics of Some Rarer B-cell Malignancies2

  • Primary mediastinal B lymphoma (subtype of DLBCL) occurs more frequently in women 30 to 40 years of age and comprises about 2% of lymphomas
  • Burkitt lymphoma, very rare, occurs most commonly in the jawbones of children in Africa but presents as an abdominal mass in US patients
  • Small lymphocytic lymphoma accounts for 5% to 10% of all lymphomas and is closely related to CLL, except that the malignant cells are located in the spleen and lymph
  • Survival rates for rarer forms10
    • Small lymphocytic lymphoma—-79.2% (closely related to CLL)
    • Mediastinal B-cell lymphoma—81.8%
    • Mantle-cell lymphoma—55.6%
    • Burkitt lymphoma—58.3%
    • Lymphoplasmacytic lymphoma—-74%

Interesting Facts11

  • In the US, a case of blood cancer is diagnosed every 3 minutes
  • Six people per hour die from blood cancer in the US
  • There are 33% more men than women living with leukemia and more men die of leukemia than women
  • More than 500,000 people in the US are either living with active NHL or are in remission
  • Age-adjusted incidence of NHL rose by 89.5% from 1975 to 2010

References

  1. SEER Survival Monograph; Chapter 28.
  2. http://www.cancer.org/cancer/non-hodgkinlymphoma/detailedguide/non-hodgkin-lymphoma-types-of-non-hodgkin-lymphoma. Accessed June 2, 2014.
  3. http://seer.cancer.gov/statfacts/html/nhl.html. Accessed June 2, 2014.
  4. http://www.cancer.org/cancer/leukemia-chroniclymphocyticcll/detailedguide/leukemia-chronic-lymphocytic-key-statistics. Accessed June 2, 2014.
  5. http://seer.cancer.gov/statfacts/html/leuks.html. Accessed June 2, 2014.
  6. http://www.cancer.org/cancer/leukemia-chroniclymphocyticcll/detailedguide/leukemia-chronic-lymphocytic-risk-factors. Accessed June 9, 2014.
  7. http://www.cancer.org/cancer/non-hodgkinlymphoma/overviewguide/non-hodgkin-lymphoma-overview-what-causes. Accessed June 2, 2014.
  8. Peveling-Oberhag J, Arcaini L, Hansmann ML, Zeuzem S. Hepatitis C-associated B-cell non-Hodgkin lymphomas. Epidemiology, molecular signature and clinical management.J Hepatol. 2013;59:169-177.
  9. Martelli M, Ferreri AJ, Agostinelli C, Di Rocco A, Pfreundschuh M, Pileri SA. Diffuse large B-cell lymphoma.Crit Rev Oncol Hematol. 2013;87:146-171.
  10. http://seer.cancer.gov/csr/1975_2011/results_single/sect_19_table.29_2pgs.pdf. Accessed June 2, 2014.
  11. http://www.lls.org/content/nationalcontent/resourcecenter/freeeducationmaterials/generalcancer/pdf/facts.pdf. Accessed June 5, 2014.