Sponsored by the Korean Society of Hematology as an annual academic project in
1377, this survey was carried out to obtain collective and authenic informations on
leukemia among Korean population.
This was the second survey on leukemia by this Society. The first survey on
leukemia was done in 1963, covering the cartes diagnosed before the end of December,
1963 and the results of this first survey was published in 1967. In the present survey,
thirty hundred and one cases of leukemia collected from 28 training hospitals during the
past 13-year period were analized.
The results of the analysis were as follows:
1. Annual incidence: The number of patients showed annual increase but the annual
ratio of the leukemic patients to the total inpatients shoved no significant change (mean
: 0.23%).
2. Sex incidence: Out of 2,936 cased, 1,779 (60.5%) were male an4 1,157 (39.4%) were
female and the sex ratio of male to female was 1.54 : 1. It was slightly higher in
children (1.89 : 1).
3. Age incidence: Out of 2,936 cases, 958 (32.6%) occurred among children under 15
years of age : 1,643 cases (56.9%) 31 ages 15-50 years: and 325 cases (11.1%) at ages
above 50 years. The peak incidence wart found in children at ages of 5-10 years.
4. Incidence according to cellular type and chronicity : 87.3% of the total was acute
leukemia and 12.2% chronic. In children below 15 years of age, 97.2% were acute.
The frequency of the major types of leukemia was as follows :
No.of cases %
Stem cell leukemia 26 0.9
Acute myelocytic leukemia 1182 39.4
Acute promyelocytic leukemia 77 2.6
Acute myelomonocytic leukemia 87 2.9
Acute monocytic leukemia 147 4.9
Acute lymphocytic leukemia 901 30.0
Erythroleukemia 44 1.5
Acute others 157 5.2
Chronic myelocytic leukemia 350 11.7
Chronic lymphocytic leukemia 14 0.5
Chronic others 3 0.1
Others 13 0.4
Acute others (157 cases) included : Acute unclaasified 130
Aleukemic leukemia 17
Sub leukemic leukemia 4
Reticulum cell leukemia 4
Plasma cell leukemia 1
Chronic others (3 cases) included : Chronic monocytic leukemia 1
Chronic myelomonocytic leukemia 1
Eosinophilic leukemia 1
Others (13cases) included : Preleukemia 1
Congenital leukemia 1
Leukemia, unspecified 11
In acute leukemia, the ratio of myelocytic to lymphocytic type was 1.31 : 1. The acute
lymphocytic leukemia was most frequently seen in the children below five years of age
and gradually decreased in number thereafter. The incidence of acute myelocytic
leukemia increased-gradually with advancing age with a peak incidence at the 15-20
years of age and decreased gradually thereafter.
In chronic leukemia, the ratio of myelocytic to Iymphocytic type was 25 : 1. The
chronic lymphocytic leukemia was very low (0.5%) and was Mainly distributed at ages
above 45 years.
The incidence of chronic myelocytic leukemia was low in children and increased
gradually with advancing age with a peak incidence at the 30-35 year, of age group and
decreased gradually thereafter.
5. Clinical manifestations
Fever, general weakness and bleeding tendency were chief complaints of most
leukemic patients especially in acute leukemia. Lymphadenopathy, hepatomegaly and
splensmegaly were frequently observed, and the frequency and degree of splenomegaly
was much more conspicuous in chronic leukemia than those of acute leukemia.
6. Laboratory findings
a) Hemoglobin value: In acute leukemia, 48.0% of the cases showed low hemoglobin
value less than 6gm/100§¢. Only 2.6% of the cases had hemoglobin more than 12gm/100
§¢. In chronic leukemia, 19.0% of the cases had hemoglobin level less than 6gm/100§¢,
and most of the cases had temoglobin level between 6 and 12gm/100§¢.
b) Leukocyte counts: In acute leukemia, 24.3% of the cases had counts below 5,000/§®
3, 16.7% between 5,000 and 10,000/§®3, 29.4% of the acute
cases had counts more than 50,000/§®3. In chronic leukemia, 71.6% of the
cases had counts more than 50,000/§®3.
c) Platelet counts: In acute leukemia, 57.8% of the cases had counts below 50,000/§®
3 and 5.4% more than 200,000/§®3 while in chronic leukemia
21.0% of the cases had counts below 50,000/§®3 and 49.8% more than
200,000/§®3.
d) Biochemistry findings: In over 30% of leukemic patients, alkaline phosphatase, LDH,
¥ã-globulin ana blood sugar were increased but Na, Ca and cholesterol were decreased.
The serum iron was increased in the acute but decreased in the chronic.
7. Treatments
In acute leukemia, 1,443 cases (56%) received chemotherapy, and single-agent
chemotherapy was done in 447 cases (31.0%), of which 358 cases (80.1%) were treated
only with steroid.
In chronic leukemia 217 crises (61%) received chemotherapy, and single-agent
chemotherapy was done in 159 cases (73.4%), of which 148 cases (94.1%) were treated
with myleran.
The rate of remission was 26.8% in acute leukemia and 45.1% in chronic leukemia.
8. Median survival time
The median survival time of 471 cases (18%) who died of acute leukemia was three
months after initial symptoms and 25 days after diagnosis (The treated: 2.5 months and
one month, respectively, the untreated: 26 days and 15 days, respectively)
The median survival time of 47 cases (12.8%) who died of chronic leukemia was 1.5
years after initial symptoms and 9.5 months after diagnosis (The treated: 1.5 years and
9 months, respectively, the untreated 5 months and one month, respectively)
9. Complications and causes of death
In acute leukemia, 235 cases (9.1%) were complicated with infection and 161 cases
(6.2%): with major bleeding, and in chronic leukemia 29 cases (8.1%) with infection and
15 cases (4.2%) with major bleeding.
Thirty two crises (9.4%) of chronic myelocytic leukemia were transformed to acute
blastic crisis, and 23 crises of leukemias (22 in acute, 1 in chronic) were complicated
with meningeal: leukemia.
Bleeding (acute, 26.3%; chronic, 25.5%) and infection racute, 16.3%; chronic, 21.3%)
were major causes of death.
In most leukemic patients the causes of death were unknown (acute, 55.4%: chronic,
76.6%).
10. The reasons for the poor results of median survival time, remission rate and low
incidence of complications (especially infection) were considered to be primarily from 1)
insufficient record of chart 2) absent statistical observations for yearly frequency 3)
insufficient follow-up.
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