Prevalence and characteristics of survivors from acute myeloid leukemia in Sweden
Authors: G Juliusson, J Abrahamsson, V Lazarevic, P Antunovic, Å Derolf, H Garelius, S Lehmann, K Myhr-Eriksson, L Möllgård, B Uggla, A Wahlin, L Wennström, M Höglund
Journal: Leukemia (2016)

The incidence of acute myeloid leukemia (AML) is documented from national cancer registries, 1,2 with limited information on specific subtypes, and the crude prevalence is known for some countries. 3,4However, the characteristics of the prevalent population are unknown.We therefore used Swedish registries to identify and characterize Swedish citizens surviving on 1 January 2014 after an AML diagnosis made during 1997 -2013 (n = 1337).They constituted 20% of a total of 6581 AML patients in the Swedish AML and NOPHO (Nordic Society of Pediatric Haematology and Oncology) Registries.The median age of survivors was 51 years at diagnosis and they were aged 59 years in 2014.The overall prevalence was 13.7 per 100 000.Seventeen percent had had acute promyelocytic leukemia (APL) or core binding factor (CBF) leukemia, and 441 (33%) had undergone allogeneic stem cell transplantation (alloSCT).Most long-term survivors had normal karyotype, but some had genetic abnormalities, including highrisk features.Long-term survivors are heterogeneous, including older people and those with intermediate/high-risk genetics, and most did not have alloSCT.The Swedish AML registry has collected extensive data from almost all (98%) adult AML cases in Swedish citizens diagnosed since 1997, 2,5,6 and survival follow-up is updated daily and complete.In this report, patients with pediatric AML diagnosed in 1997 -2013 were added from the complete Swedish part of the NOPHO database.This thus permits a comprehensive analysis of the current prevalent population following a diagnosis of AML since 1997.Data including updated survival were extracted in April 2015, and we chose to analyze the prevalence on 1 January 2014, to ensure adequate reporting.Genetic results, including molecular data (FLT3-ITD, NPM1 mutation), were prospectively reported from 2007, whereas karyotype, but no molecular data, was retrospectively retrieved from patients diagnosed in 1997 -2006, as previously reported. 6CEBPA mutations were only reported since 2012, and were therefore not analyzed.Standard descriptive statistical analysis using Statistica 12 software (Tulsa, OK) was performed.At data extraction the registry contained files on 6289 adult patients and 292 pediatric patients diagnosed since 1 January 1997, all with complete survival update, except for nine emigrants.On 1 January 2014 there were 1337 people surviving (20.3%) following an AML diagnosis, of which 661 were males (49%) and 676 females.Characteristics of the surviving patients are given in Table 1.There were 217 living patients diagnosed in 2013, and 244 diagnosed in 2011 -2012, and thus 876 (66%) had survived 3 years or more, including 344 (26%) who had survived 10 years or more.The overall prevalence was 13.7 per 100 000 inhabitants (males 13.2 and females 13.9 per 100 000), which is similar to the reported corresponding prevalence of AML in the other Nordic countries as on 31 December 2012 (range 12.2 -16.8 per 100 000). 4Incidence and prevalence by sex and 5-year age cohorts are shown in Figures 1a andb.