Epidemiologia das leucemias agudas e crônicas no Brasil, 1990- 2021

Abstract

Introduction: Leukemias are malignant diseases that affect the bone marrow, the organ responsible for producing blood and immune cells, which replicate uncontrollably and replace the body's normal, functional cells. Leukemia is the most common type of cancer among young people up to 20 years old and is the 13th most frequent type of cancer in Brazil. Objective: To analyze the incidence and mortality of acute and chronic myeloid and lymphoid leukemias in Brazil. Methods: This is an ecological, time-series study of the incidence and mortality rates of acute lymphoid leukemia (ALL), chronic lymphoid leukemia (CLL), acute myeloid leukemia (AML), and chronic myeloid leukemia (CML) with data corrected and estimated by the Global Burden of Diseases Study 21 (GBD21) for Brazil, by sex and age group, from 1990 to 2021. Agestandardized rates were calculated considering the GBD standard population and expressed per 100,000. Trends were analyzed by the Average Annual Percent Change (AAPC) and a 95% confidence interval using Joinpoint regression. Results: For ALL, there was a decreasing trend in the analyzed rates; regarding incidence, the rates were 1.16 (1990) and 1.01 (2021) in men (AAPC of -0.50%; 95% CI -0.7;-0.3) and 0.92 (1990) and 0.86 (2021) in women (AAPC of -0.17% 95% CI -0.35;0.0). For mortality, there was a decrease from 1.02 (1990) to 0.83 (2021), with an AAPC of -0.63% (95% CI -0.76;-0.53) in women. For AML, the age-standardized incidence rate in men increased from 1.91 in 1990 to 2.13 in 2021, with an AAPC of 0.33% (95% CI 0.22;0.41), while in women, the rate increased from 1.66 to 1.68, with an AAPC of 0.03% (95% CI -0.08; 0.13). Regarding mortality, the age-standardized AML rate in men increased from 1.89 (1990) to 2.16 (2021), with an AAPC of 0.47% (95% CI 0.37;0.56). In women, the rate increased from 1.65 to 1.84, with an AAPC of 0.44% (95% CI 0.32;0.57). For CLL, the age-standardized incidence rate in men increased from 0.63 in 1990 to 0.88 in 2021, with an AAPC of 1.25% (95% CI 1.0;1.5). In women, the rate increased from 0.45 to 0.57, with an AAPC of 0.72% (95% CI 0.57;0.94). Regarding mortality, the age-standardized CLL rate in men increased from 0.59 in 1990 to 0.65 in 2021, with an AAPC of 0.49% (95% CI 0.25;0.74). On the other hand, for CML, the age-standardized incidence rate in men decreased from 1 in 1990 to 0.47 in 2021, with an AAPC of -2.34% (95% CI -2.41;-2.28). In women, the rate decreased from 0.7 to 0.28, with an AAPC of -3.00% (95% CI -3.09;-2.9). The agestandardized mortality rate for CML in men decreased from 1.06 in 1990 to 0.57 in 2021, with an AAPC of -2.06% (95% CI -2.14;-1.98). In women, the rate decreased from 0.84 to 0.34, with an AAPC of -2.84% (95% CI -2.93;-2.73). Conclusion: In Brazil, there was an increase in incidence for CLL in both sexes and an increase in mortality for men. AML showed an increase in incidence for men and an increase in mortality for both sexes. There was a decrease in incidence for both sexes in ALL and CML; ALL mortality decreased in women, and CML was the only group where mortality decreased for both sexes; other rates remained stable. Relevance and impacts: These findings are consistent with those observed worldwide. Studying these neoplasms is essential to direct efforts, incentives, and investments in research and innovation in targeted therapies, as well as to design public health policies to address hematological neoplasms.