Temporal changes in survival among adult patients with acute lymphoblastic leukemia diagnosed in the period 1998-2020 – A Danish nationwide population-based study

Abstract

Abstract Previous studies have shown continuous improved overall survival (OS) for adults with acute lymphoblastic leukemia (ALL) up to 2015. However, since 2015 several important advances have been made justifying a more contemporary analysis of outcomes in adult ALL. Here we quantify progress in OS for adult Danish patients with ALL diagnosed between 1998 and 2020 using flexible parametric survival models. This population-based study includes 657 patients and demonstrates a significant improvement in OS over time with the 2-year age standardized OS increasing from 36.2% (95% CI, 26.8–45.6%) in 1998 to 68.5% (95% CI, 60.1–76.9) in 2020, corresponding to an absolute increase in 2-year OS of 32.3 percent points (95% CI, 19.3–45.4) during the surveyed period. Stratified analysis revealed improvements for both Philadelphia chromosome positive and negative ALL, across cytogenetic risk classes, and for B- and T-cell ALL, whereas the latter did not reach statistical significance. Additionally, in age strata improvements were seen across all ages; however, most pronounced for the younger patients ≤ 60 years. These results indicate a universal and continuous improvement in the treatment of adult ALL. Currently, novel treatment combination and advances in cellular therapy occur rapidly, and we expect even further improvements in the years to come.