Global, regional, and national burden of leukemia and its five subtypes, 1990-2021, with forecasts to 2050

Objective: Leukemia remains the most prevalent and lethal hematologic malignancy worldwide, yet comprehensive long-term analyses by subtype and future projections remain limited. Therefore, we conducted a systematic assessment of the global burden of total leukemia and its five subtypes from 1990 to 2021, with projections to 2050. Methods: Using data from the Global Burden of Disease Study (GBD) 2021, we estimated age-standardized incidence, mortality, and disability-adjusted life years (DALYs) rates for total leukemia and five subtypes: acute lymphoid leukemia, chronic lymphoid leukemia (CLL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), and other leukemia. Estimates were stratified by age, sex, region, and Socio-demographic Index, with 95% uncertainty intervals (UIs). We quantified the burden attributable to high body mass index, smoking, and occupational exposure. Projections to 2050 were generated using the GBD 2021 forecast framework. Results: Between 1990 and 2021, global age-standardized incidence, mortality, and DALY rates of total leukemia declined from 6.9 (95% UI, 6.2-7.5) to 5.6 (4.8-6.2), from 5.6 (5.0-6.1) to 3.9 (3.3-4.2), and from 226.3 (195.5-258.9) to 136.9 (111.9-153.7) per 100,000 population, respectively. CML showed the largest decreases across incidence (–54.6%), mortality (–61.1%), and DALY rates (–63.5%). Males experienced consistently higher burden than females across all subtypes. Among modifiable risk factors, AML accounted for the highest DALY burden. High body mass index was the leading global risk factor for total leukemia (8.7 [6.6-11.2] per 100,000), while tobacco use was the dominant contributor for CLL (1.7 [0.6-2.9]). Projections to 2050 indicate stable DALY rates for most subtypes, with the exception of CLL, which is expected to rise substantially. Conclusions: Leukemia remains a major global health challenge, driven by aging populations and rising obesity. Reducing future burden requires targeted prevention, early detection, and improved access to diagnostics and long-term care.