Risk assessment and predictive modeling of suicide in Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL) Patients.

Background: Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) predominantly affects older adults and is characterized by a prolonged disease course. While overall survival has improved, the psychosocial burden, including suicide risk, remains underexplored.​ METHODS: A retrospective cohort study was conducted using data from 95,517 patients diagnosed with CLL/SLL between 2000 and 2021 from the SEER 17 registry. LASSO regression was utilized for variable selection, followed by univariate and multivariate Cox proportional hazards and Fine-Gray competing risk analyses to identify independent predictors. A nomogram was developed based on significant predictors and validated using time-dependent receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).​ RESULTS: The cohort's mean age was 69.2 years, with 21.6% aged ≥ 80 years and a male-to-female ratio of 1.5:1; 88.8% were White. Although the suicide rate was low (0.1%), multivariate analysis showed that male sex, non-married status, lower income, and White race were significantly associated with increased suicide risk. Advanced age (≥ 80) was significant in Cox but not in competing risk models. The nomogram demonstrated good predictive accuracy (AUC > 0.71 at 3, 5, and 10 years) and clinical utility.

Conclusions: Sociodemographic factors, including sex, race, marital status, and income, are independently associated with suicide risk in CLL/SLL patients. The developed nomogram offers a practical, evidence-based tool for early identification of high-risk individuals, thereby facilitating targeted psychosocial interventions and improving survivorship care.

Implications for cancer survivors: CLL/SLL survivors who are male, unmarried, or of lower socioeconomic status face heightened suicide risk, highlighting the critical need for tailored psychosocial support within survivorship care.