Journal: Nature reviews. Clinical oncology
This review article examines global patterns in acute myeloid leukemia (AML), emphasizing disparities between high-income and low-/middle-income countries (LMICs).
Key points:
- Epidemiology and trends
- AML is an aggressive hematologic malignancy whose incidence rises sharply with age.
- Incidence appears higher in wealthier regions, in part due to population aging and better diagnostic capabilities.
- Many LMICs report lower incidence but substantially higher AML-related mortality and morbidity, reflecting underdiagnosis, delayed diagnosis, and limited treatment access.
- Disparities in care and outcomes
- Over the past decade, outcomes have improved in high-income countries due to:
- Availability of multiple new targeted and novel agents.
- Enhanced supportive care.
- Wider and safer use of allogeneic hematopoietic stem cell transplantation.
- In contrast, patients in many LMICs still depend primarily on older cytotoxic chemotherapy regimens—when these are available at all—leading to poorer survival and higher treatment-related complications.
- Risk factors
- Predisposition to AML arises from:
- Germline genetic variants.
- Environmental and lifestyle exposures.
- Prior cytotoxic chemotherapy and radiation.
- Certain pre-existing medical conditions and comorbidities.
- The distribution and impact of these risk factors vary geographically and are influenced by local environmental exposures and healthcare systems.
- Data gaps and infrastructure needs
- Incomplete or inconsistent cancer registry coverage, especially in LMICs, limits accurate estimates of incidence, survival, and treatment patterns.
- The authors underscore the need to:
- Strengthen cancer registry infrastructure and global surveillance.
- Use artificial intelligence and advanced analytics to better integrate and interpret heterogeneous data.
- Promote more equitable access to diagnostics, modern therapies, transplant, and clinical trials across regions.
Overall, the review frames AML as a model for global oncology inequities and calls for coordinated efforts to reduce diagnostic, therapeutic, and research gaps between high-income settings and the rest of the world.