Estimates of the incidence of hematological neoplasms in Spain, 2021: Study of the Spanish Network of Cancer Registries (REDECAN)

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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Distribution of myeloid neoplasms according to subtype in REDECAN&#44; 2002&#8211;2013 and 2021 projections&#46;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">AML&#58; acute myeloid leukaemia&#59; IQR&#58; interquartile range&#59; MDS&#58; myelodysplastic syndrome&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Haematologic neoplasms are a group of diseases with well-established clinical characteristics but with very heterogeneous histological profiles&#46; In addition&#44; increased molecular and genomic knowledge of this group of diseases has led to the fine-tuning of some definitions and nomenclatures and the discovery of new entities&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Currently&#44; the World Health Organization classifies hematologic malignancies into 17 broad categories differentiated mainly according to the lineage of the affected cells&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A study on the burden of cancer disease found that in 2017 there were around 1&#46;4 million incident cases of haematologic malignancies worldwide and non-Hodgkin&#39;s lymphoma was among the 10 most common cancers with the highest absolute number of years of life lost&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Since the emergence of the SARS-COV-2 virus and the consequent restructuring of the healthcare system&#44; a delay in overall medical consultation has been observed&#44; including patients who start to develop cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In addition&#44; the reluctance or fear of the patients themselves to go to health centres may also have contributed to this delay&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In general&#44; the prognosis of cancer is closely linked to the time of diagnosis and intervention and&#44; in this sense&#44; the impact on diagnostic delay may have been devastating&#46; In fact&#44; it is estimated that the excess mortality from cancer derived from this pandemic will reach its maximum in the next 2 years&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In the case of haematologic malignancies&#44; the first data show a delay that translates into a diagnosis of the disease in more advanced stages&#44; characterized&#44; for example&#44; by leukocytosis in the case of acute leukemias or voluminous tumour masses in the case of lymphomas&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">On the other hand&#44; SARS-COV-2 infection itself may have also had a strong impact on the prognosis of cancer patients who&#44; due to treatments or the disease itself&#44; are usually immunosuppressed&#46; Although some initial studies suggest that the prognosis of patients with certain types of haematologic malignancy and COVID-19 is comparable to that of the general population that has also acquired the infection&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> population-based studies are necessary to establish the real impact of the pandemic on each type of neoplasm&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Population-based prediction studies of cancer cases based on time series analysis have proven effective in establishing cancer incidence and mortality&#44; as the margin of error between estimated and actual figures is irrelevant for health management policies&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Knowing the number of cancer cases expected for 2021 in a context of an unprecedented pandemic is vitally useful for health planning in the coming years&#46; In this regard&#44; we hypothesise that by the time actual incidence figures for 2021 become available&#44; the results obtained in this study will help to determine the impact of COVID-19 on this group of diseases and to assess its impact on incidence in subsequent years&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The aim of this study is to determine the new cases of the different subtypes of haematologic malignancy in Spain by 2021 based on the population incidence observed in the Spanish Network of Cancer Registries &#40;REDECAN&#41; for 2002&#8211;2013&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Methods</span><p id="par0050" class="elsevierStylePara elsevierViewall">Data on haematologic malignancies collected in the population registries participating in REDECAN were included&#46; REDECAN currently has a single standardized joint database for this type of neoplasm that includes data from 2002 to 2013&#46; Specifically&#44; data from the population-based cancer registries &#40;PCR&#41; of &#193;lava&#44; Asturias &#40;2002&#8211;2010&#41;&#44; Bizkaia&#44; Castell&#243;n &#40;2004&#8211;2013&#41;&#44; Ciudad Real &#40;2004&#8211;2011&#41;&#44; Cuenca &#40;2002&#8211;2011&#41;&#44; Gipuzkoa&#44; Girona&#44; Gran Canaria&#44; Granada&#44; La Rioja&#44; Mallorca &#40;2003&#8211;2012&#41;&#44; Murcia &#40;2002&#8211;2010&#41;&#44; Navarra &#40;2002&#8211;2012&#41;&#44; Tarragona and Tenerife were included&#46; These records cover around 26&#37; of the total Spanish population registered in January 2013 &#40;12&#44;143&#44;157 out of a total of 47&#44;129&#44;783&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">PCRs use various sources of information and procedures to identify cases of neoplasms and include them in the registry&#46; The main sources of information for the registries participating in REDECAN are the anatomical pathology reports which are complemented by the diagnoses performed in haematology laboratories &#40;flow cytometry&#44; cytogenetics and molecular biology studies&#41; following international recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> To include a case in the registry&#44; it is necessary to verify the malignancy and specify the diagnostic basis&#44; as well as to record the information based on coding standards&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Specifically&#44; to identify incident cases of haematologic malignancies&#44; tumour records containing a morphological definition between codes 959 and 999 according to the International Classification of Diseases for Oncology-3rd edition<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> were included&#44; irrespective of the location of the primary tumour&#46; Tumors were regrouped following the 2008 and 2017 World Health Organization guidelines<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;13</span></a> and the HAEMACARE project&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> as shown in Appendix <a class="elsevierStyleCrossRef" href="#sec0050">B</a> Supplementary Table 1&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The quality indicators were defined based on the standards of the <span class="elsevierStyleItalic">International Agency for Research on Cancer</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Specifically&#44; the quality indicators of the PCRs showed that 96&#46;7&#37; of the cases included were verified microscopically&#44; 5&#37; were unspecific cases&#44; and 1&#46;1&#37; were cases reported to the registry solely on the basis of death certificates&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The population data for the calculation of the incidence rates were obtained from the figures of the resident population according to year&#44; province&#47;islands and gender provided by the National Institute of Statistics&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Likewise&#44; population projection data were obtained for the year 2021 in Spain&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">This study has been conducted using anonymized data from the participating PCRs&#46; For their part&#44; the PCRs comply with the legal regulations in force in Spain&#44; Organic Law 3&#47;2018 on the Protection of Personal Data&#44; and European Regulation 2016&#47;679&#46; The PCRs belong to and comply with the regulations of the <span class="elsevierStyleItalic">International Association of Cancer Registries</span> and the <span class="elsevierStyleItalic">International Agency for Research on Cancer</span>&#46; No intervention has been performed on humans or animals&#46; No informed consent from patients is required for this type of study&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">A descriptive analysis of the data was performed using the median and interquartile range &#40;IQR&#41; for the quantitative variables&#44; and absolute frequencies and percentages for the categorical ones&#46; Crude incidence rates &#40;CR&#41; and age-adjusted incidence rates &#40;AR&#41; were calculated based on the 2013 European standard population<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and expressed per 100&#44;000 population&#46; Poisson regression models were used to analyse trends in incidence rates and estimate the annual percentage of change &#40;APC&#41; for each neoplasm subtype&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Specific rates by age for the year 2021 were estimated by applying the APCs for the period 2002&#8211;2013&#46; The projection of the number of cases of haematologic malignancies for 2021 was determined by applying to the Spanish population of 2021 the age-specific rates estimated for that same year&#44; assuming a stable incidence trend over time&#46; Statistical analyses were performed using the R version 3&#46;6&#46;1 software&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Characteristics of hematologic malignancies&#44; 2002&#8211;2013</span><p id="par0090" class="elsevierStylePara elsevierViewall">Between 2002 and 2013&#44; a total of 56&#44;777 haematologic malignancies were registered in the participating PCRs&#44; 55&#37; corresponded to men and the median &#91;IQR&#93; age at diagnosis was 69 &#91;54&#8211;78&#93; years&#46; A total of 39&#44;156 &#40;69&#37;&#41; of the tumours corresponded to lymphoid neoplasms&#44; 17&#44;522 &#40;30&#46;8&#37;&#41; were myeloid neoplasms&#44; and 99 cases &#40;0&#46;2&#37;&#41; were recorded as histiocytosis&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Regarding lymphoid neoplasms&#44; 55&#37; corresponded to men and the median &#91;IQR&#93; age at diagnosis was 67 &#91;52&#8211;77&#93; years&#46; The distribution of these neoplasms according to subtype&#44; as well as the median age of each subtype according to sex can be seen in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; Multiple myeloma was the most common lymphoid neoplasm subtype &#40;19&#37;&#41;&#44; followed by diffuse large B-cell lymphoma &#40;17&#46;7&#37;&#41; and chronic lymphocytic leukaemia&#47;small lymphocytic lymphoma &#40;15&#46;7&#37;&#41;&#44; the latter more common in men than in women &#40;58&#46;4&#37; vs&#46; 41&#46;6&#37;&#41;&#46; Overall&#44; the median age of lymphoblastic leukemias was 18 &#91;IQR&#58; 5&#8211;51&#93; years&#46; In general&#44; age at diagnosis of lymphoid neoplasms was higher in women than in men&#44; except for Hodgkin&#39;s lymphoma&#44; mycosis fungoides&#47;S&#233;zary syndrome&#44; and hairy cell leukaemia&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">55&#37; of myeloid neoplasms were diagnosed in men&#59; the median age at diagnosis was 73 &#91;IQR&#58; 60&#8722;81&#93; years&#46; The most common specific subtypes were essential thrombocythemia&#44; accumulating 13&#46;7&#37; of cases&#44; followed by chronic myeloid leukaemia &#40;7&#46;6&#37;&#41; and polycythaemia vera &#40;6&#46;1&#37;&#41;&#44; although it is necessary to take into account a high number of acute myeloid leukaemia and non-specific or unclassified myelodysplastic syndromes &#40;MDS&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the distribution of myeloid neoplasms according to all the subtypes analysed&#46; In general&#44; the age at the time of diagnosis of this type of neoplasm was higher in women &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Incidence&#44; trends and projections for 2021</span><p id="par0105" class="elsevierStylePara elsevierViewall">The total number of haematologic malignancies estimated for the year 2021 in all of Spain was 25&#44;879&#46; <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a> show the projections of lymphoid and myeloid neoplasms according to sex&#44; respectively&#46; Total projections can be found in Appendix <a class="elsevierStyleCrossRef" href="#sec0050">B</a> Supplementary Table 2&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">The CR of lymphoid neoplasms for the period 2002&#8211;2013 was 31&#46;2&#8201;&#215;&#8201;100&#44;000 pop&#46; &#40;95&#37; CI&#58; 30&#46;9&#8211;31&#46;5&#41; and AR 34&#46;2&#8201;&#215;&#8201;100&#44;000 pop&#46; &#40;95&#37; CI&#58; 33&#46;9&#8211;34&#46;6&#41;&#46; The APC of the observed incidence was 0&#46;3 &#40;95&#37; CI&#58; &#8722;0&#46;1 to 0&#46;6&#41; projecting a CR 36&#46;7&#8201;&#215;&#8201;100&#44;000 pop&#46; &#40;95&#37; CI&#58; 35&#46;9&#8211;37&#46;6&#41; and AR of 35&#46;7&#8201;&#215;&#8201;100&#44;000 pop&#46; &#40;95&#37; CI&#58; 34&#46;9&#8211;36&#46;5&#41; for 2021 in Spain&#46; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> shows the annual AR according to gender&#46; Specifically&#44; the projections estimated a total of 17&#44;385 &#40;95&#37; CI&#58; 16&#44;982&#8211;17&#44;788&#41; new cases of lymphoid neoplasms for 2021&#44; 9&#44;751 &#40;95&#37; CI&#58; 9&#44;447&#8211;10&#44;055&#41; in men and 7&#44;634 &#40;95&#37; CI&#58; 7&#44;370&#8211;7&#44;899&#41; in women&#46; The 3 most common lymphoid neoplasms projected for 2021 were diffuse large B-cell lymphoma &#40;19&#46;3&#37;&#41;&#44; multiple myeloma &#40;19&#46;2&#37;&#41;&#44; and follicular lymphoma &#40;15&#46;0&#37;&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the sex-specific projections of lymphoid neoplasms in Spain for 2021 by subtype&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">In the case of myeloid neoplasms for the period 2002&#8211;2013&#44; the CR was 14&#8201;&#215;&#8201;100&#44;000 pop&#46; &#40;95&#37; CI&#58; 13&#46;8&#8211;14&#46;2&#41; and AR 15&#46;5&#8201;&#215;&#8201;100&#44;000 pop&#46; &#40;95&#37; CI&#58; 15&#46;3&#8211;15&#46;7&#41;&#46; The APC was 0&#46;7 &#40;95&#37; CI&#58; 0&#46;3&#8211;1&#46;2&#41; and the estimated CR and AR for 2021 in Spain were 17&#46;8&#8201;&#215;&#8201;100&#44;000 pop&#46; &#40;95&#37; CI&#58; 17&#46;2&#8211;18&#46;5&#41; and 17&#46;2&#8201;&#215;&#8201;100&#44;000 pop&#46; &#40;95&#37; CI&#58; 16&#46;6&#8211;17&#46;8&#41;&#44; respectively&#46; In total&#44; 8&#44;446 &#40;95&#37; CI&#58; 8&#44;145&#8211;8&#44;747&#41; new cases of myeloid neoplasms were projected for 2021&#44; 4&#44;689 &#40;95&#37; CI&#58; 4&#44;464&#8211;4&#44;914&#41; in men and 3&#44;757 &#40;95&#37; CI&#58; 3&#44;557&#8211;3&#44;957&#41; in women&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows estimates of the number of cases and incidence rates of myeloid neoplasms in Spain for 2021 according to sex and subtype&#46; Essential thrombocythemia &#40;16&#46;8&#37;&#41;&#44; MDS with multilineage dysplasia &#40;8&#37;&#41;&#44; and polycythaemia vera &#40;6&#46;6&#37;&#41; were the most common specific subtypes in the predictions for 2021&#59; on the other hand&#44; the frequency of unspecific cases decreased considerably with respect to the distribution observed in 2002&#8211;2013&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">The results of this study estimate that&#44; in 2021&#44; around 26&#44;000 new cases of haematologic malignancies should be diagnosed in Spain&#46; However&#44; the current pandemic situation&#44; as well as the first published results on the impact of COVID-19 on health care in general and cancer diagnosis in particular&#44; indicate that there may be a delay in the identification of new cases of cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> In the case of hematologic tumours&#44; in which patients usually show higher levels of immunosuppression and greater susceptibility to infections&#44; COVID-19 could have a different impact compared to patients who started with solid tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> In fact&#44; in a study in which hospitalized cancer patients were analysed according to the type of neoplasm&#44; it was observed that those with haematologic malignancies showed higher rates of SARS-COV-2 infection and required more supportive interventions than those with another type of tumour&#46; In addition&#44; compared with cancer patients without COVID-19&#44; leukaemia was the only type of cancer that registered a higher mortality during the analysed pandemic period&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Estimates for 2021 show that diffuse large B-cell lymphomas become the most common subtype among lymphoid neoplasms on a par with multiple myeloma&#46; Diffuse large B-cell lymphomas are themselves a heterogeneous group of biologically distinct entities that may be aggressive but curable and result in clonal proliferation of malignant germline or postgermline B cells&#46; Despite numerous investigations&#44; the standard treatment for the vast majority of this type of neoplasm has been&#44; for decades&#44; R-CHOP chemotherapy &#40;rituximab&#44; cyclophosphamide&#44; doxorubicin&#44; vincristine and prednisone&#41;&#44; but disease control decreases from 90&#37; to 60&#37; of cases when diagnosed in advanced stages<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#59; in this sense&#44; it is necessary to intensify efforts to avoid an excessive diagnostic delay that implies identifying cases in more advanced stages&#46; Multiple myeloma is associated with both cellular and humoral immune dysfunction and causes a state of generalised immunosuppression&#44; leaving patients particularly vulnerable to infection&#46; Due to the ageing of the population&#44; it seems logical that the incidence of multiple myeloma may increase considerably in the coming years as it is particularly diagnosed in those over 65 years of age&#46; Patients suffering from this disease require significant human and health care resources for their follow-up and treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> In addition&#44; treatment indications are unclear for a significant percentage of geriatric patients with multiple myeloma&#44; as the benefits of treatment options have been evaluated in clinical trials in which participants tend to be younger and with fewer comorbidities&#46; On the other hand&#44; the effect of COVID-19 or other potential new infections in patients with multiple myeloma is of particular concern because of a poorly understood disease-associated immunosuppression&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Regarding the projections of myeloid neoplasms&#44; the data show that essential thrombocythemia continues to be the subtype with the highest incidence&#46; Patients diagnosed with this disease generally have a good prognosis&#44; especially if it does not progress to polycythaemia vera or primary myelofibrosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;24</span></a> Risk stratification based on history of thrombosis&#44; JAK2 mutations&#44; age &#40;&#62;60 years&#41; and cardiovascular risk factors may influence therapeutic strategy and prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Some studies suggest that a proportion of essential thrombocythemia diagnoses are still made after a thrombotic event&#44; and that they undergo the first haematological evaluation after a long history of thrombocytosis&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> In this sense&#44; it would be advisable to influence the diagnostic criteria among primary care physicians&#44; intensifying care in those patients with a history of thrombocytosis&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The group of MDS and myeloproliferative neoplasms&#44; especially chronic myelomonocytic leukaemia but also&#44; although less prevalent&#44; atypical chronic myeloid leukaemia and unclassifiable MDS&#47;myeloproliferative neoplasms&#44; increased in 2021 compared to previous periods&#46; The increase in MDS with multilineage dysplasia is particularly striking&#46; The aetiology of this <span class="elsevierStyleItalic">de novo</span> disease is unknown&#44; and exposure to certain environmental toxicants may increase the risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;26</span></a> It is estimated that 15&#37; and 28&#37; will progress to acute leukaemia 2 and 5 years after diagnosis&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Between 30&#37; and 50&#37; of MDS have cytogenetic alterations and up to 90&#37; of mutations are identified when a targeted panel is used<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#59; these alterations will determine the prognosis of the patients&#44; so the detection of these alterations should be a priority objective in the care setting&#46; Indeed&#44; cytogenetics and sequencing techniques have revolutionised diagnosis in recent years and may be partly the reason for the increased incidence of MDS to the detriment of most non-specific neoplasms&#46; In addition&#44; they help to identify responders to treatment and consequently establish improvements in survival&#44; as well as in the efficacy of drug use and treatment costs&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">An interesting fact derived from this study is the decrease in non-specific haematologic malignancies&#46; As mentioned above&#44; the continuous advances in genetic and molecular diagnostic techniques&#44; as well as the specific training that has been carried out over the last few years in population-based cancer registries&#44; have led to an optimisation in the diagnosis and coding of this type of disease&#46; However&#44; this finding should be taken with caution as the set of non-specific cases does not individually form a disease type&#44; and therefore does not constitute a random variable in the implementation of the statistical model&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Another limitation of this study could be related to coding biases in the specific subgroups of malignancy between the different population-based registries&#59; however&#44; overall&#44; the data for the major disease groups are concordant and&#44; in addition&#44; a significant improvement in coding for non-specific cases has been observed in recent years and in all registries participating in this study&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> On the other hand&#44; it is necessary to point out the low statistical power of some very rare neoplasm subtypes that might have influenced the projections&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Projections on the number and rates of new cancer cases should be interpreted with caution as they are based on subpopulations that have varied considerably in recent years due to improvements in diagnosis and coding&#46; However&#44; the methods and strategy used in data analysis provide a reasonably accurate estimate of the current incidence of hematologic malignancies in Spain&#44; based on the greater population coverage currently provided by registries in this country&#46; Finally&#44; the projections presented here may be underestimated due to the continuous improvement in the identification of haematological malignancies by population-based registries and the emergence of more effective molecular diagnostic tools&#46; In any case&#44; the improvement in all these aspects reinforces the validity of the population data and strengthens the health planning decisions that can be made based on them&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In conclusion&#44; knowing the number of expected haematological malignancy cases by 2021 may be useful to assess the impact of SARS-COV-2 infection on the diagnosis of this type of disease when factual information on cancer incidence becomes available&#46; In addition&#44; the projections presented here can serve as a basis for resource planning to implement innovative diagnostic methods such as cytogenetics and next-generation DNA sequencing&#44; which provide information not only on diagnosis but also on prognosis&#46; They can also provide guidance for targeted treatments&#44; some of which result in increased survival rates&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of interests</span><p id="par0160" class="elsevierStylePara elsevierViewall">There is no conflict of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">See components of the Spanish Network of Cancer Registries &#40;REDECAN&#41; in the <a class="elsevierStyleCrossRef" href="#sec0055">Appendix 1</a>&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Sanvisens A&#44; Ameijide A&#44; Carulla M&#44; Marcos-Gragera R&#46; Estimaciones de la incidencia de las neoplasias hematol&#243;gicas en Espa&#241;a&#44; 2021&#58; estudio de la Red Espa&#241;ola de Registros de C&#225;ncer &#40;REDECAN&#41;&#46; Med Clin &#40;Barc&#41;&#46; 2022&#59;158&#58;284&#8211;290&#46;</p>"
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            "apendice" => "<p id="par0175" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
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            "apendice" => "<p id="par0180" class="elsevierStylePara elsevierViewall">Spanish Network of Cancer Registries &#40;REDECAN&#41;&#58; <span class="elsevierStyleBold">Girona Cancer Registry <span class="elsevierStyleItalic">&#8211; Coordination of the haematologic malignancies group in REDECAN</span>&#58;</span> Rafael Marcos-Gragera&#44; Montse Puigdemont&#44; Anna Vidal-Vila&#44; Marta Solans&#44; Arantza Sanvisens&#59; <span class="elsevierStyleBold">Tarragona Cancer Registry &#8211; <span class="elsevierStyleItalic">data coordination in REDECAN</span>&#58;</span>Mari&#224; Carulla&#44; Alberto Ameijide&#44; Cl&#224;udia Pla&#44; Jaume Galceran&#59; <span class="elsevierStyleBold">&#193;lava Cancer Registry&#58;</span> Arantza L&#243;pez de Munain&#44; Patricia Sancho&#44; M&#46;<span class="elsevierStyleSup">a</span> Luisa Iruretagoyena&#59; <span class="elsevierStyleBold">Albacete Cancer Registry&#58;</span> Katia del Pozo&#59; <span class="elsevierStyleBold">Asturias Cancer Registry&#58;</span> Susana Merino Perera&#44; Virginia Men&#233;ndez-Garc&#237;a&#44; Marta Rodr&#237;guez-Camblor&#59; <span class="elsevierStyleBold">Bizkaia Cancer Registry&#58;</span> Visitaci&#243;n de Castro&#44; Marta de la Cruz&#44; Joseba Bidaurrazaga&#59; <span class="elsevierStyleBold">Castell&#243;n Tumor Registry&#58;</span> Emilia Banqueri&#44; Consol Sabater&#44; Javier Pe&#241;alver&#59; <span class="elsevierStyleBold">Ciudad Real Cancer Registry&#58;</span> Matilda Chico&#59; <span class="elsevierStyleBold">Cuenca Cancer Registry&#58;</span> Ana Isabel Marcos&#44; Rosario Jimenez-Chillar&#243;n&#59; <span class="elsevierStyleBold">Gipuzkoa Cancer Registry&#58;</span> Leire Gil&#44; Amaia Aizurura&#44; Nerea Larra&#241;aga&#59; <span class="elsevierStyleBold">Gran Canaria Cancer Registry&#58;</span> M&#46;<span class="elsevierStyleSup">a</span> Dolores Rojas-Martin&#44; Emilio de Miguel&#44; Mar&#237;a-Carmen Gabas&#59; <span class="elsevierStyleBold">Granada Cancer Registry&#58;</span> Mar&#237;a-Jos&#233; S&#225;nchez&#44; Daysi Yoe-Ling Chang-Chan&#59; Rafael Rios-Tamayo&#59; <span class="elsevierStyleBold">La Rioja Cancer Registry&#58;</span> Josefina Perucha&#59; <span class="elsevierStyleBold">Mallorca Cancer Registry&#58;</span> Patricia Ruiz-Armengol&#44; Carmen S&#225;nchez-Contador&#59; <span class="elsevierStyleBold">Murcia Cancer Registry&#58;</span> M&#46;<span class="elsevierStyleSup">a</span> Dolores Chirlaque&#44; Antonia S&#225;nchez-Gil&#44; Ricardo-Jos&#233; Vaamonde&#59; <span class="elsevierStyleBold">Navarra Cancer Registry&#58;</span> Marcela Guevara&#44; Eva Ardanaz&#59; <span class="elsevierStyleBold">Tenerife Cancer Registry&#58;</span> M&#46;<span class="elsevierStyleSup">a</span> Araceli Alem&#225;n Herrera&#44; Leonor-Olga Vel&#225;quez&#44; M&#46;<span class="elsevierStyleSup">a</span> Magdalena Ramos-Marrero&#59; <span class="elsevierStyleBold">Castilla y Le&#243;n Cancer Registry&#58;</span> Pilar Gutierrez&#44; Rufino Alamo&#44; Lorena Estevez&#59; <span class="elsevierStyleBold">Spanish Registry of Childhood Tumors&#58;</span> Rafael Peris&#44; Adela Canete&#59; <span class="elsevierStyleBold">Registry of Child and Adolescent Tumours of the Valencian Community&#58;</span> Ana Vizcaino&#44; Fernando Almela&#46;</p>"
            "etiqueta" => "Appendix 1"
            "titulo" => "Spanish Network of Cancer Registries &#40;REDECAN&#41;"
            "identificador" => "sec0055"
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                  \t\t\t\t">1&#41; Hodgkin lymphomas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;11 &#40;0&#46;05&#8722;0&#46;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">2&#41; Non-Hodgkin lymphomas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#44;895 &#40;8&#44;610&#8211;9&#44;180&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;1 Precursor cell lymphoid neoplasms&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;1&#46;1 B-lymphoblastic leukaemia&#47;lymphoma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;1&#46;2 T-lymphoblastic leukaemia&#47;lymphoma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;1&#46;3 Lymphoblastic leukaemia&#47;lymphoma&#44; NOS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">2&#46;2&#41; Mature B-cell neoplasms&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;2&#46;1 Chronic lymphocytic leukaemia &#47;Small lymphocytic lymphoma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">828 &#40;745&#8722;911&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;2&#46;2 Prolymphocytic leukaemia&#44; B cells&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;4&#8722;16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;2&#46;3 Hairy cell leukaemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">82 &#40;54&#8722;109&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;36 &#40;0&#46;25&#8722;0&#46;47&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;7&#8722;36&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;09 &#40;0&#46;03&#8722;0&#46;15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;08 &#40;0&#46;03&#8722;0&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;2&#46;4 Marginal zone lymphoma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">657 &#40;569&#8722;745&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">563 &#40;479&#8722;646&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;33 &#40;1&#46;98&#8722;2&#46;68&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;1 &#40;1&#46;77&#8722;2&#46;43&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;2&#46;5 Lymphoplasmacytic lymphoma&#47;Waldenstr&#246;m macroglobulinemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">269 &#40;212&#8722;326&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;16 &#40;0&#46;91&#8722;1&#46;41&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;19 &#40;0&#46;94&#8722;1&#46;44&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">163 &#40;117&#8722;210&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">2&#46;2&#46;6 Multiple myeloma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1914 &#40;1763&#8722;2065&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#46;25 &#40;7&#46;6&#8722;8&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#46;43 &#40;7&#46;76&#8722;9&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1434 &#40;1312&#8722;1555&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;94 &#40;5&#46;43&#8722;6&#46;44&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;35 &#40;4&#46;91&#8722;5&#46;78&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;2&#46;7 Follicular lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1279 &#40;1176&#8722;1382&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;51 &#40;5&#46;07&#8722;5&#46;96&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;63 &#40;5&#46;18&#8722;6&#46;08&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1328 &#40;1218&#8722;1438&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;5 &#40;5&#46;04&#8722;5&#46;96&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;95 &#40;4&#46;52&#8722;5&#46;38&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;2&#46;8 Mantle cell lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">234 &#40;189&#8722;280&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;01 &#40;0&#46;81&#8722;1&#46;21&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;03 &#40;0&#46;82&#8722;1&#46;24&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">112 &#40;79&#8722;145&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;46 &#40;0&#46;33&#8722;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;42 &#40;0&#46;29&#8722;0&#46;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;2&#46;9 Diffuse large B-cell lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1804 &#40;1662&#8722;1945&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;78 &#40;7&#46;17&#8722;8&#46;39&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;94 &#40;7&#46;34&#8722;8&#46;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1560 &#40;1426&#8722;1695&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">6&#46;46 &#40;5&#46;91&#8722;7&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5&#46;82 &#40;5&#46;33&#8722;6&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;2&#46;10 Burkitt&#39;s lymphoma&#47;leukaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">108 &#40;75&#8722;142&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;47 &#40;0&#46;32&#8722;0&#46;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;48 &#40;0&#46;33&#8722;0&#46;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">47 &#40;25&#8722;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;19 &#40;0&#46;1&#8722;0&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;17 &#40;0&#46;09&#8722;0&#46;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;2&#46;11 Hodgkin&#39;s and non-Hodgkin&#39;s composite lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;4&#8722;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;04 &#40;0&#46;02&#8722;0&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;04 &#40;0&#46;02&#8722;0&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;3&#8722;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;03 &#40;0&#46;01&#8722;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;03 &#40;0&#46;01&#8722;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;3&#41; T-cell and NK-cell neoplasms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">671 &#40;585&#8722;756&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;89 &#40;2&#46;52&#8722;3&#46;26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;95 &#40;2&#46;59&#8722;3&#46;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">425 &#40;358&#8722;493&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;76 &#40;1&#46;48&#8722;2&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;58 &#40;1&#46;33&#8722;1&#46;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;3&#46;1 Mycosis fungoides&#47;S&#233;zary syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">220 &#40;173&#8722;267&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;95 &#40;0&#46;75&#8722;1&#46;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;5&#46; Chronic neutrophilic&#47;eosinophilic leukaemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;4&#46; Myelodysplastic&#47;myeloproliferative neoplasm&#44; nonspecific&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">3&#41; Myelodysplastic syndromes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;8 &#40;3&#46;41&#8722;4&#46;19&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;1&#46; MDS with unilineage dysplasia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">95 &#40;79&#8722;112&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;41 &#40;0&#46;34&#8722;0&#46;48&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;43 &#40;0&#46;35&#8722;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">67 &#40;52&#8722;82&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;28 &#40;0&#46;22&#8722;0&#46;34&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;2&#46; MDS with ring sideroblasts and unilineage dysplasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">90 &#40;68&#8722;112&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;39 &#40;0&#46;29&#8722;0&#46;48&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;4 &#40;0&#46;3&#8722;0&#46;51&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">73 &#40;45&#8722;101&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;3 &#40;0&#46;19&#8722;0&#46;42&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;26 &#40;0&#46;16&#8722;0&#46;36&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;3&#46; MDS with excess blasts&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">301 &#40;248&#8722;353&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;3 &#40;1&#46;07&#8722;1&#46;52&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;36 &#40;1&#46;1&#8722;1&#46;61&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">132 &#40;96&#8722;168&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;55 &#40;0&#46;4&#8722;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;46 &#40;0&#46;32&#8722;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;4&#46; MDS with multilineage dysplasia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">453 &#40;415&#8722;490&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;95 &#40;1&#46;79&#8722;2&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;04 &#40;1&#46;87&#8722;2&#46;21&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">224 &#40;194&#8722;254&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;93 &#40;0&#46;8&#8722;1&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;79 &#40;0&#46;68&#8722;0&#46;89&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;5&#46; MDS associated with isolated &#40;5q&#41; deletion&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19 &#40;10&#8722;29&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59 &#40;44&#8722;74&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;6&#46; Unclassifiable MDS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">633 &#40;553&#8722;713&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">524 &#40;439&#8722;608&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">4&#41; Acute myeloid leukaemia and precursor cell neoplasms&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;95 &#40;4&#46;47&#8722;5&#46;44&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">961 &#40;856&#8722;1066&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;98 &#40;3&#46;55&#8722;4&#46;42&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;39 &#40;2&#46;99&#8722;3&#46;78&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;1&#46; AML with recurrent cytogenetic abnormalities&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;2&#46; AML with multilineage dysplasia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;3&#46; Therapy-related myeloid neoplasm&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;4&#46; AML not otherwise specified&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;5&#46; Nonspecific AML&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#41; Acute leukaemia of ambiguous lineage&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;1&#46; Acute leukaemia&#44; nonspecific&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;2&#46; Biphenotypic acute leukaemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#41; Myeloid neoplasm&#44; nonspecific&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#46;1&#46; Myeloid leukaemia&#44; nonspecific&nbsp;\t\t\t\t\t\t\n
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