Age-standardized incidence, mortality rates, mortality-to-incidence ratios, and disability-adjusted life years for acute lymphoblastic leukemia in the European Union 15 + countries, Australia, and United States of America.

person Akhil Jain Mercy Catholic Medical Center, Darby, PA info_outline Akhil Jain, Chinmay Jani, Sagar Patel, Maharshi Raval, Harpreet Singh

Authors person Akhil Jain Mercy Catholic Medical Center, Darby, PA info_outline Akhil Jain, Chinmay Jani, Sagar Patel, Maharshi Raval, Harpreet Singh Organizations Mercy Catholic Medical Center, Darby, PA, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, Landmark Medical Center, Woonsocket, RI, Landmark Medical Hospital, New York, NY Abstract Disclosures Research Funding No funding received None. Background: Though acute lymphoblastic leukemia (ALL) has been described historically more frequently in children, its burden has been increasing in adults. Therefore we aimed to describe ALL's age-standardized rates in incidence (ASIR), mortality (ASMR), and disability-adjusted life years (DALYs) between 1990-2019 between countries with comparable healthcare structure. Methods: Using the International Classification of Diseases versions 10 and 9, we extracted data from the Global Burden of Disease Study database for European Union (EU 15+) countries, Australia and USA. Individual countries' ASIR, ASMR, and DALYs stratified by sex were extracted for 1990-2019, and mortality-to-incidence indices (MII) were calculated. The indices were reported per 100,000 people. Results: ASIRs increased globally (males +60.35%, females +57.02%) as well as in all countries, with the highest in Portugal for males (+315.4%) and females (+195.06%). ASIR increase was less than global aggregate figures in Australia and Norway. USA had decreasing ASIR for males (-19%) and minimal change in females (+1%). ASMR decreased globally (males -15.75%, females -21.45%), all countries had decreasing ASMR across males and females with the highest decrease for males in Denmark (-56.28%) and females in Portugal (-56.16%). More importantly, MII had decreased globally, reaching 50% change both in males and females. USA observed lesser decrease in MII for males (-11%) and females (-24%) whereas all other EU countries and Australia had larger changes ( > 50%). Though Italy had the highest ASIR (males 11.54, females 8.33) as well as ASMR (males 0.71, females 0.46) in 2019, its MII had large changes (males -70%, females -54%). DALYs decreased in males (-20.23%) and females (-26.86%) globally. Decrease in Australia was more pronounced in Australia (males -50%, females -47%) than USA (males -36%, females -30%) and many other EU countries. Greece had smallest decrease in DALYs (males -16.04%) and Austria (females -16.92%). Conclusions: Though the incidence is increasing, mortality of ALL is decreasing globally for males and females. MII and DALYs have also decreased for males and females despite increased ASIR. This reflects the success on multiple fronts including precise diagnosis and prognostication, and the utility of dose-intensive chemotherapy, which can achieve sustainable complete remission. Implementing monoclonal antibodies in first-line treatment over the next few years will improve disease control.