Leukemia epidemiology in China: Burden, trends, and determinants in the 21st century

This comprehensive review integrates population-based registries, hospital databases and Global Burden of Disease data to describe the evolving leukemia burden in China from 2000 to 2022. The overall incidence has stabilized nationally, but the absolute number of cases continues to increase as the population ages. A bimodal age pattern persists, with acute leukemias clustering in young children and older adults, while chronic forms predominate in mid-to-late life, and males are consistently more affected by all subtypes. Rapid expansion of haploidentical hematopoietic stem cell transplantation has resulted in marked survival gains for both acute myeloid leukemia and acute lymphoblastic leukemia, and its seamless integration with molecularly targeted agents, venetoclax-based regimens and chimeric antigen receptor T-cell therapy has transformed acute leukemias into potentially curable diseases for an expanding proportion of patients. In parallel, universal access to tyrosine kinase inhibitors and standardized molecular monitoring have turned chronic myeloid leukemia into a manageable chronic condition, and survival of patients with chronic lymphocytic leukemia is improving as novel Bruton's tyrosine kinase and BCL-2 inhibitors diffuse into clinical practice. Tobacco, obesity, benzene and radon remain the principal modifiable drivers of leukemogenesis. Strengthening data completeness, widening equitable access to precision therapies and controlling these environmental risks are essential to sustaining the observed continuous improvement in leukemia patient survival and ensuring that ever more Chinese patients achieve a cure or durable disease control in the decades ahead.