Epidemiology, survival, and treatment of acute myeloid and lymphoblastic leukaemia in Germany: a nationwide population-based registry analysis

Background: Acute leukaemias are rare but highly aggressive malignancies, but only limited population-level data are available for Germany. We aimed to describe epidemiology, survival, and therapies of acute myeloid leukaemia (AML) and acute lymphoblastic leukaemia (ALL) in Germany using nationwide cancer registry data. Methods: We conducted a population-based analysis of all incident cases of AML and ALL in Germany, identified via ICD codes from mandatory cancer registry reporting, to assess incidence, treatment, and survival outcomes. Findings: We identified 25,788 patients with AML and 6480 patients with ALL diagnosed between 2016 and 2021 aged 0-101 years. The age-standardized incidence rate was 4.72/100,000 for AML (median age 72.8 years, IQR 61.0-80.3) and 1.36/100,000 for ALL (median age 19.4 years, IQR 5.2-58.6). The three- and five-year overall survival was 29.0% (95% CI: 28.3-29.7) and 23.8% (95% CI: 23.1-24.7) in AML, and 64% (95% CI: 62.2-65.9) and 58% (95% CI: 55.7-60.2) in ALL. Survival was highly dependent on age, with children (0-18 years) showing the highest three-year survival rates in AML (76.4%, 95% CI: 70.2-83.2) and ALL (91.9%, 95% CI: 89.8-94.1) compared to older adults. Moreover, area-based income and social deprivation were linked to survival, with three-year survival reduced by up to 4% in lower-income counties. Based on German federal population estimates, AML cases are expected to rise by 14.6%, while ALL cases will decline by 2.3% between 2020 and 2050. Interpretation: We provide incidence and survival data to inform future clinical trials, guide resource allocation, and support healthcare planning to improve real-world outcomes and address disparities in acute leukaemia. Funding: German Research Foundation (DFG).