Epidemiology and etiology Epidemiology

Leukemia is a relatively uncommon disease overall. The current overall age-adjusted annual incidence of acute leukemia in the United States has remained relatively stable at 10 per 100,000. Of the estimated 1.4 million new cancers diagnosed in 2009, only

1% to 2% will be acute leukemia, with 760 cases of ALL and about 12,800 cases of

AML. ' Interesting age-related patterns of disease exist in ALL and AML. The aver age age of diagnosis for AML is about 65 years and is a result of an increasing incidence of AML with age.4 ALL is a more common process in children than adults and relatively uncommon in adults where its incidence decreases with age.5,6

In the pediatric population, leukemia is a common disease, accounting for almost one-third of all childhood malignancies. ALL accounts for 75% to 80% of all cases of childhood leukemia, whereas AML accounts for no more than 20%. Males generally are affected more often than females in all but the infant age group, and its incidence is higher in whites than among other racial groups. The incidence of AML in children is bimodal: It peaks at 2 years of age, decreases steadily thereafter to age 9 years, and then increases again at around age 16.

The 5-year event-free survival (EFS) rate for ALL is nearly 80% in children as compared to only 40% for adults.1 The success rate for children with ALL is attributed to enrollment in clinical trials, risk-adapted treatment, and integration of

presymptomatic CNS prophylaxis. A recent increase in the survival rate for adults has been attributed to the adoption of the principles of treatment that characterize pediatric protocols.8 For patients with AML, a similar pattern exists. Those younger than 20 years of age have a 5-year survival of 50%6 Patients with AML older than age 60 generally have a poorer prognosis with a 5-year survival of less than 20%.9

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