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

David Baden; Nadine Wolgast; Philipp M Altrock; Sophie Steinhäuser; Jakob Voran; Thomas Beder; Manuel Hecht; Cornelia Baden; Lorenz Bastian; Cécile Ronckers; Jacqueline Müller-Nordhorn; Soo-Zin Kim-Wanner; Martin Neumann; Lars Fransecky; Gunnar Cario; Christoph Röllig; Alexander Katalinic; Claudia D Baldus

doi:10.1016/j.lanepe.2025.101503

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

Lancet Reg Health Eur. 2025 Oct 18:59:101503. doi: 10.1016/j.lanepe.2025.101503. eCollection 2025 Dec.

Authors

David Baden^{1

2}, Nadine Wolgast^{1

2

3}, Philipp M Altrock^{1

3

4}, Sophie Steinhäuser^{1

2}, Jakob Voran⁵, Thomas Beder^{1

2}, Manuel Hecht^{1

2}, Cornelia Baden^{1

2}, Lorenz Bastian^{1

2

3}, Cécile Ronckers⁶, Jacqueline Müller-Nordhorn⁷, Soo-Zin Kim-Wanner⁸, Martin Neumann^{1

2

3}, Lars Fransecky^{1

2}, Gunnar Cario^{2

3

9}, Christoph Röllig¹⁰, Alexander Katalinic^{2

11}, Claudia D Baldus^{1

2

3}

Affiliations

¹ Department of Medicine II, Haematology and Oncology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany.
² University Cancer Centre Schleswig-Holstein, University Hospital Schleswig-Holstein, Kiel, Germany.
³ Clinical Research Unit CATCH ALL (KFO 5010), Kiel, Germany.
⁴ Department of Theoretical Biology, Max Planck Institute for Evolutionary Biology, Ploen, Schleswig-Holstein, Germany.
⁵ Department of Internal Medicine III, Cardiology and Intensive Care, University Hospital Schleswig-Holstein, Kiel, Germany.
⁶ Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University, Main, Germany.
⁷ Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Nuremberg, Germany.
⁸ Hessian Cancer Registry, Hessian Office for Health and Care, Frankfurt, Germany.
⁹ Department of Paediatrics I, ALL-BFM Study Group, Christian-Albrechts University Kiel and University Medical Centre Schleswig-Holstein, Kiel, Germany.
¹⁰ Medical Department I, University Hospital of TU Dresden, Dresden, Germany.
¹¹ Institute for Social Medicine and Epidemiology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Lübeck, Germany.

Abstract

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).

Keywords: Acute leukaemia; Acute lymphoblastic leukaemia (ALL); Acute myeloid leukaemia (AML); Epidemiology; Outcomes; Socioeconomic differences.