Mortality trends in chronic myeloid leukemia in the United States: A population-based analysis

Abstract

Abstract Introduction Chronic Myeloid Leukemia (CML) accounts for roughly 15% of the newly diagnosed adult leukemias. Prognosis has improved markedly over the past two decades due to the advent and adoption of BCR-ABL1 tyrosine kinase inhibitors (TKIs). Despite these advances, literature suggests persistent disparities in CML mortality by gender, race/ethnicity, and socioeconomic status. We sought to utilize the CDC WONDER database to provide a comprehensive, stratified assessment of CML mortality trends across socio-demographic and geographic subgroups, investigating whether ongoing inequities exist in CML outcomes. Methods A retrospective analysis was conducted using death certificate data from the CDC WONDER 1999-2020 dataset, focusing on the cause of death due to CML via the ICD-10 code C92.1. Those above the age of 45 were included; the data was stratified by sex, race/ethnicity, and census region. Statistical analyses for the Age-Adjusted Mortality Rate (AAMR) per 100,000 persons, Annual Percentage Change (APC), and Average Annual Percentage Change (AAPC) were calculated using joinpoint regression. Results Between 1999 and 2020, there were 32,484 CML-related deaths in the United States. The AAMR declined across the entire study period (1.45/100,000 to 0.63/100,000). There was a pronounced decrease from 1999 to early 2006 (APC -8.50% for males and -8.30% for females, with the decline plateauing in the following years). Males consistently exhibited higher AAMRs than females throughout the study period. In 2020, the AAMR among White individuals was 0.68, compared to 0.57 for Black individuals, 0.45 for Hispanic individuals, and 0.37 for Asian individuals. Over the study period, White individuals had a slower decline in mortality (AAPC: -3.1%) compared to Black (-4.2%), Hispanic (-4.9%), and Asian individuals (-5.1%). In 2020, the AAMRs were 0.71 (Midwest), 0.65 (West), 0.60 (South), and 0.57 (Northeast). The APC from 1999–2020 for the Midwest was -3.2%, compared to -3.5% (West), -3.8% (South), and -4.1% (Northeast). Notably, from 2018 to 2020, a slight increase in AAMR was observed across all groups. Discussion The substantial reduction in CML mortality over the past two decades aligns with the widespread adoption of TKIs, particularly imatinib (approved 2001). The subsequent approval of dasatinib (2006), nilotinib (2007), and bosutinib (2012) has aided in the transformation of CML from a fatal disease to a chronic condition for most patients. Despite recent declines in age-adjusted mortality rates from targeted therapies, disparities do exist. Males and White individuals face higher apparent mortality rates. The slight uptick in mortality from 2018 to 2020 may be related to the increased vulnerability of patients with hematologic malignancies to severe COVID-19 infection.