The Epidemiology and Molecular Aspects of Chronic Lymphocytic Leukemia: A lifelong journey

Chronic lymphocytic leukemia (CLL) is the most prevalent form of leukemia in the Western world. Over the past decades, our understanding of CLL has significantly advanced, leading to improvements in diagnostics, novel treatments, and better patient outcomes. However, most of these advancements stem from randomized controlled trials involving select patient populations, which may not fully represent everyday clinical practice. This highlights the need for population-based registries to assess the general effectiveness of treatments, especially in older patients with comorbidities. Accordingly, this thesis relies on data from the Netherlands Cancer Registry to study trends in CLL epidemiology, including incidence and survival estimates (part II), and the effectiveness of various therapeutic strategies in different molecular subgroups of CLL patients (part III). It also explores alternative clinical endpoints, such as adverse events, treatment discontinuation, and quality of life, particularly in older, unfit patients (part IV). Finally, given the significant improvements in CLL outcomes, the thesis examines long-term complications, including secondary malignancies, Richter transformation, and causes of death (part IV). Overall, the aim is to provide a comprehensive overview of the epidemiology and molecular aspects of CLL from diagnosis to death.