Global Burden of Chronic Myeloid Leukemia: A Systematic Analysis for the Global Burden of Disease Study 2017

Abstract

Introduction: Chronic myeloid leukemia (CML) is a clonal hematopoietic stem cell disorder characterized by the presence of the Philadelphia chromosome. Current pharmacotherapeutic modalities can induce long-term durable remissions through treatment with tyrosine-kinase inhibitors (TKIs). Access to specialized care and TKIs globally have improved outcomes in CML. A comprehensive description of the global burden of CML can further direct health policy, resource allocation, access, research, and patient care. Objective: To describe the burden of CML for 21 world regions and 195 countries and territories from 1990 to 2017. Design and Setting: We report incidence, mortality, and disability-adjusted life-year (DALY) estimates for CML derived from the Global Burden of Disease (GBD) 2017 study. Data sources for the GBD study include vital registration systems and cancer registries. We also analyzed changes in age-standardized incidence and death rates from 1990 to 2017 and 2007 to 2017 globally, by region, and by sociodemographic index (SDI). Main Outcomes and Measures: CML incidence; mortality; and DALYs by age, sex, country, and year. Results: Globally, there were 39,846 (95% uncertainty interval [UI], 36,909 to 42,842) incident cases of CML in 2017 with an age-standardized incident rate (ASIR) of 0.5 cases (95% UI, 0.47 to 0.54) per 100,000 person-years. There were 24,055 deaths (95% UI, 22,233 to 26,072) attributed to CML with an age-standardized death rate (ASDR) of 0.31 deaths (95% UI, 0.28 to 0.33) per 100,000 person-years. In 2017, CML contributed 654,984 DALYs (95% UI, 594,727 to 712,948). The three world regions with the highest ASIRs were Australasia, Western Europe, and Eastern Sub-Saharan Africa. The three world regions with the highest ASDRs were Eastern Sub-Saharan Africa, Central Sub-Saharan Africa, and South Asia. From 1990 to 2017, the global ASIR and ASDR has decreased by 42.4% (95% UI, 39% to 46%) and 48% (95% UI, 46% to 51%), respectively. All SDI regions saw a decline in ASIR and ASDR since 1990; however, the largest decline in ASIR and ASDR were seen in High SDI countries. Conclusions and Relevance: Incidence and mortality of CML is variable among countries but has largely declined since 1990. The largest declines were seen in High SDI countries; however, lack of access to confirmatory testing may underreport CML incidence in low- and middle-income countries (LMICs). Collaborative efforts have been implemented to overcome educational, access, and socioeconomic barriers. Global health priorities for CML should be directed to expand these efforts and improve upon existing or build data reporting systems. Research priorities should focus on assessing the impact of these efforts.