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Incidence rate, long-term survival, and loss-of-life expectancy of children with acute lymphoblastic leukemia: a nation-wide analysis of Taiwan during 1997-2015
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  • Chi-Wei Tsai,
  • Meng-Yao Lu,
  • Alice Lin Tsing Yu,
  • Jung-Der Wang
Chi-Wei Tsai
National Cheng Kung University College of Medicine
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Meng-Yao Lu
National Taiwan University Hospital
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Alice Lin Tsing Yu
Chang Gung Memorial Hospital Linkou Main Branch
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Jung-Der Wang
National Cheng Kung University College of Medicine

Corresponding Author:[email protected]

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Acute lymphoblastic leukemia (ALL) is the number one cancer in children worldwide. Survival with ALL in children has shown a steady improvement over time with contemporary chemotherapy. This study aimed to determine the incidence rates and lifetime health impacts of pediatric ALL in Taiwan. A total of 3,854 patients with the diagnosis of ALL (ICD-9-CM code: 2040) were collected from the Registry for Catastrophic Illness (RCI) between 1997 and 2015 to assure the diagnostic accuracy. We included 2,044 cases for the final analysis. All patients were followed-up until the end of 2017 by linkage with the National Mortality Registry of Taiwan. A survival extrapolation method was applied and validated to estimate the lifetime survival function for life expectancy (LE) and loss-of-life expectancy (loss-of-life LE). The cohort included 1,222 males and 822 females. The average incidence rates (IRs) of pediatric ALL from 1997 to 2015 for age strata of <1, 1-4, 5-9, 10-14, 15-18 were 1.24, 3.39, 2.21, 1.56, and 0.97 per 100,000 person-year, respectively. The cumulative incidence rate up to age 18 (CIR0-18) of pediatric ALL increased after 2001, and was more pronounced in males than females. Most patients received treatments based on the protocol of Taiwan pediatric oncology group (TPOG)-ALL-97 (23.0%) or TPOG-ALL-2002 (62.7%). After extrapolation of survival to age 80, we found LE and loss-of-LE of pediatric ALL were 54.5 and 15.2 years, respectively. Future studies should explore long-term survival for different groups at risk of pediatric ALL and impacts of ALL on the society.