A NATIONWIDE STUDY OF CHRONIC LYMPHOCYTIC LEUKEMIA INCIDENCE AND MORTALITY IN THE REPUBLIC OF KOREA

초록

Background: In East Asian countries, the incidence of chronic lymphocytic leukemia (CLL) is lower than in Western countries, and the use of novel agents is difficult due to various practical issues. Ibrutinib monotherapy for relapsed or refractory CLL has been reimbursed since 2018. As of September 2023, it just started to be covered by insurance for use as frontline therapy. In this current reality, we conducted a nationwide study to evaluate the incidence and mortality of CLL in the Republic of Korea for the establishment of a treatment scheme in the future. Methods: Information on patients diagnosed with CLL between January 1, 2006 and December 31, 2021 was collected from the National Health Insurance Database, which contains data on more than 97% of insured patients. Results: There has been a gradual increase in the incidence rate of CLL per 100,000 persons since 2006. Given the high incidence of CLL in individuals over the age of 60, it is believed that the aging of the population has contributed significantly to the increase in CLL incidence. The mortality rate began to rise, exceeding 10% from the age of 70 and showing a rising trend up to 30% with increasing age, and was higher in men than in women. The median overall survival of the 3,743 CLL patients identified in this study was 7.915 years (95% confidence interval: 7.389-8.309 years). Of a total of 3,743 patients, 542 (14.48%) received no treatment during follow-up, while 3,145 patients (84.02%) received any form of treatment, including those who received cytotoxic chemotherapy or novel agents. Allogeneic hematopoietic stem cell transplantation was performed in 56 patients (1.5%). Overall survival did not show significant differences between the no treatment, any treatment without transplantation, and transplantation groups. Conclusions: Considering that any treatment, including transplantation, was administered only to the high-risk patient group with active and progressive disease, these interventions may equalize the overall survival of these patients with those in the low-risk group who do not require treatment. Further research is needed to determine whether early treatment initiation can lead to an increase in overall survival beyond the results of this study and to explore the potential benefits of allogeneic stem cell transplantation in patient populations in the era of novel agents.