CLL Prognosis By Age: Information for Patients and Caregivers

Chronic lymphocytic leukemia (CLL) is a type of cancer that affects the blood and bone marrow. It tends to progress slowly but can become more aggressive over time. While more common in older people, CLL can also affect younger adults.

Vijendra Singh, MD, medical oncologist and member of the Hematology Oncology Multidisciplinary Team at the Barbara Ann Karmanos Cancer Institute in Detroit, and Daniel Landau, MD, a board-certified medical oncologist and hematologist at Orlando Health Cancer Institute and subject matter expert for The Mesothelioma Center, explain how age affects the prognosis of CLL.

While CLL can be serious, many people with CLL do not require treatment at diagnosis, according to Dr. Singh and Dr Landau. The five-year survival rate for CLL in people 20 years of age and older is 88%, based on the most recent Surveillance, Epidemiology, and End Results (SEER) data (collected between 2013 and 2019). This means that, on average, 88 out of 100 people with CLL will still be alive five years after their initial diagnosis.

“Treatment of CLL has had a paradigm shift in the past decade, where treatment has changed from a chemotherapy-based treatment to more targeted non-chemotherapy-based therapies, which are well tolerated,” Dr. Singh said. These advances have continually improved survival rates for CLL patients.

CLL life expectancy and prognosis may vary based on several factors, including your age. For example, those diagnosed as older adults (65 and older) may also have comorbidities (other medical conditions) that need to be considered. Having a cardiac, pulmonary, or kidney condition impacts medication selection and the expected outcome of treatment.

Dr. Landau, who says the other medical issues you have play a more significant role than age alone, added that, “some therapies may raise blood pressure; some may increase bleeding risk; and some may damage the kidneys.” He stressed the importance of a thorough assessment of existing conditions when determining the best treatment options.

CLL prognosis also depends on the stage of the disease. For instance, those with more advanced stages of CLL (known as “high-risk”) may not live as long as those with earlier stages 0 to III. Also, the genetic disease features play a role in prognosis. This includes IGHV mutational status and cytogenetic changes like del17p.

Below is a summary of the prognosis for CLL patients based on age groups according to SEER data collected by the National Cancer Institute (NCI).

CLL prognosis younger than 60

The prognosis for CLL is generally good for those younger than 60 years old. Those younger than 54 account for just 1.5% of all CLL-related deaths. The five-year survival rate for those under 50 was 94.2% in 2015.

CLL prognosis in your 60s

The prognosis for CLL in people aged 60 to 69 is also in the same range as those under 60. As of 2015, the five-year relative survival rate for those aged 50 to 64 was 94.7% – an increase from years prior.

CLL prognosis in your 70s

The five-year relative survival rate for those aged 65 and older was 84.8% in 2015 – lower than the average for all ages combined (88%). This is likely due to other health issues that may arise in older patients in combination with a diagnosis of CLL.

CLL prognosis 80 and older

The five-year relative survival rate for people 80 and older is difficult to ascertain, due to comorbidities and biological age. In other words, people with CLL can pass away due to other reasons besides their CLL.

The five-year relative survival rate for the age groups listed above include everyone with CLL, whether they are receiving treatment or not. Research published in the British Journal of Haematology in 2018 looked at the outcome of CLL in people 80 and older following treatment – which does not apply to everyone, as some patients may not be undergoing treatment – and cites the median overall survival to be 48.3 months. However, this is median, meaning the data shows 50% above and 50% below that number.

Certain risk factors may influence the prognosis of CLL, including:

• Stage

• Cytogenetic (FISH) findings

• Karyotype complexity

• IGHV status

• Several scoring systems, like the CLL-IPI

CLL is not considered curable, but many people with this type of cancer live a long and healthy life. The prognosis varies greatly between individuals, though people diagnosed at an earlier stage often have a better prognosis. Your genetic makeup, age, and overall health also influence your outlook.

The development of new treatments within the last decade, such as targeted therapies and monoclonal antibodies, has dramatically improved the outlook. “In patients who need therapy, with the way the therapies have shifted over the years, many will live a normal or near normal life span with CLL,” Dr. Landau said.

Living with a cancer diagnosis is emotionally and physically challenging. The goal of treatment is to give you the best possible quality of life with minimal symptoms for years to come. Your healthcare team will help guide you through your treatment options and provide support throughout the process.

It’s essential to stay informed about your condition so you can make decisions based on the most up-to-date information available. A healthy diet, regular exercise, and stress-reducing activities can help you manage CLL's physical and emotional side effects.

Finding connection and support through a patient community or online support group can be incredibly helpful. Sharing your story and learning from others creates a sense of empowerment and connection. Above all, remember that every person’s journey with CLL is unique.

“Even though these therapies won’t likely cure the disease,” Dr. Landau said, “they can control it in the long term.”