Original Article | Published:

Chronic Myeloproliferative Neoplasias

The EUTOS population-based registry: incidence and clinical characteristics of 2904 CML patients in 20 European Countries

Leukemia volume 29, pages 13361343 (2015) | Download Citation


This population-based registry was designed to provide robust and updated information on the characteristics and the epidemiology of chronic myeloid leukemia (CML). All cases of newly diagnosed Philadelphia positive, BCR-ABL1+ CML that occurred in a sample of 92.5 million adults living in 20 European countries, were registered over a median period of 39 months. 94.3% of the 2904 CML patients were diagnosed in chronic phase (CP). Median age was 56 years. 55.5% of patients had comorbidities, mainly cardiovascular (41.9%). High-risk patients were 24.7% by Sokal, 10.8% by EURO, and 11.8% by EUTOS risk scores. The raw incidence increased with age from 0.39/100 000/year in people 20–29 years old to 1.52 in those >70 years old, and showed a maximum of 1.39 in Italy and a minimum of 0.69 in Poland (all countries together: 0.99). The proportion of Sokal and Euro score high-risk patients seen in many countries indicates that trial patients were not a positive selection. Thus from a clinical point of view the results of most trials can be generalized to most countries. The incidences observed among European countries did not differ substantially. The estimated number of new CML cases per year in Europe is about 6370.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    , , , on behalf of the European LeukemiaNet. Chronic myeloid leukaemia. Lancet 2007; 370: 342–50.

  2. 2.

    , , , , , et al. Success story of targeted therapy in chronic myeloid leukemia: a population-based study of patients diagnosed in Sweden from 1973 to 2008. J Clin Oncol 2011; 29: 2514–2520.

  3. 3.

    , , , , , et al. Improved survival in chronic myeloid leukemia since the introduction of imatinib therapy: a single-institution historical experience. Blood 2012; 119: 1981–1987.

  4. 4.

    , , , , , et al. European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013. Blood 2013; 122: 872–884.

  5. 5.

    , , , , , et al. Chronic Myelogenous Leukemia, Version 1.2014. J Natl Compr Canc Netw 2013; 11: 1327–1340.

  6. 6.

    . Chronic myelogenous leukaemia market. Nat Rev Drug Discov 2009; 8: 447–448.

  7. 7.

    , , . Estimation of the increasing prevalence and plateau prevalence of chronic myeloid leukemia in the era of tyrosine kinase inhibitor therapy. Cancer 2012; 118: 3123–3127.

  8. 8.

    Experts in Chronic Myeloid Leukemia (Kantarjian H. et al.). The price of drugs for chronic myeloid leukemia (CML) is a reflection on the unsustainable prices of cancer drugs: from the perspective of a large group of CML experts. Blood 2013; 121: 4439–4442.

  9. 9.

    , , , , , et al. Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med 2003; 348: 994–1004.

  10. 10.

    , , , , , et al. Phase III, randomized, open-label study of daily imatinib mesylate 400 mg versus 800 mg in patients with newly diagnosed, previously untreated chronic myeloid leukemia in chronic phase using molecular end points: tyrosine kinase inhibitor optimization and selectivity study. J Clin Oncol 2010; 28: 424–430.

  11. 11.

    , , , , , et al. Nilotinib versus imatinib for newly diagnosed chronic myeloid leukemia. N Engl J Med 2010; 362: 2251–2259.

  12. 12.

    , , , , , et al. Dasatinib versus imatinib in newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med 2010; 362: 2260–2270.

  13. 13.

    , , , , , et al. Bosutinib versus imatinib in newly diagnosed chronic-phase chronic myeloid leukemia: results from the BELA trial. J Clin Oncol 2012; 30: 3486–3492.

  14. 14.

    , , , , , et al. Deletions of the derivative chromosome 9 do not influence the response and the outcome of chronic myeloid leukemia in early chronic phase treated with imatinib mesylate: GIMEMA CML Working Party analysis. J Clin Oncol 2010; 28: 2748–2754.

  15. 15.

    , , , , , et al. Frontline imatinib treatment of chronic myeloid leukemia: no impact of age on outcome, a survey by the GIMEMA CML working party. Blood 2011; 117: 5591–5599.

  16. 16.

    , , , , , et al. Imatinib plus peginterferon alfa-2a in chronic myeloid leukemia. N Engl J Med 2010; 363: 2511–2521.

  17. 17.

    , , , , , et al. Tolerability-adapted imatinib 800 mg/d versus 400 mg/d versus 400 mg/d plus interferon-α in newly diagnosed chronic myeloid leukemia. J Clin Oncol 2011; 29: 1634–1642.

  18. 18.

    , , , , , et al. Imatinib for newly diagnosed patients with chronic myeloid leukemia: incidence of sustained responses in an intention-to-treat analysis. J Clin Oncol 2008; 26: 3358–3363.

  19. 19.

    , , , , , et al. Early responses predict better outcomes in patients with newly diagnosed chronic myeloid leukemia: results with four tyrosine kinase inhibitor modalities. Blood 2013; 121: 4867–4874.

  20. 20.

    , , , , , et al. Predicting complete cytogenetic response and subsequent progression-free survival in 2060 patients with CML on imatinib treatment: the EUTOS score. Blood 2011; 118: 686–692.

  21. 21.

    , , , , , et al. The EUTOS prognostic score: review and validation in 1288 patients with CML treated frontline with imatinib. Leukemia 2013; 27: 2016–2022.

  22. 22.

    , , , , , et al. Tyrosine kinase inhibitor usage, treatment outcome, and prognostic scores in CML: report from the population-based Swedish CML registry. Blood 2013; 122: 1284–1292.

  23. 23.

    , , , , , et al. Prognostic discrimination in ‘good-risk’ chronic granulocytic leukemia. Blood 1984; 63: 789–799.

  24. 24.

    , , , , , et al. A new prognostic score for survival of patients with chronic myeloid leukemia treated with interferon alfa. J Natl Cancer Inst. 1998; 90: 850–858.

  25. 25.

    Waterhouse JAH, Muir CS, Correa P, Powell J (eds). Cancer incidence in five continents. IARC: Lyon, France, 1976; 3: 456.

  26. 26.

    , , , , , et al. Impact of additional cytogenetic aberrations at diagnosis on prognosis of CML: long-term observation of 1151 patients from the randomized CML Study IV. Blood 2011; 118: 6760–6768.

  27. 27.

    , , , , , et al. Additional chromosomal abnormalities in Philadelphia-positive clone: adverse prognostic influence on frontline imatinib therapy: a GIMEMA Working Party on CML analysis. Blood 2012; 120: 761–767.

  28. 28.

    , , , , , et al. Multicenter independent assessment of oucomes in chronic myeloid leukemia patients treated with imatinib. J Natl Cancer Inst 2011; 103: 553–561.

  29. 29.

    , , , . Age and sex distribution of haematological malignancies in the UK. Hematol Oncol 1997; 15: 173–189.

  30. 30.

    , , , . The incidence and outcome of myeloid malignancies in 2112 adult patients in south-east England. Haematologica 2006; 91: 1400–1404.

  31. 31.

    , , , , , et al. Clinical trials underestimate the age of chronic myeloid leukemia (CML) patients. Incidence and median age of Ph/BCR-ABL-positive CML and other chronic myeloproliferative disorders in a representative area in Germany. Leukemia 2009; 23: 602–604.

  32. 32.

    , , , , , et al. Incidence of hematologic malignancies in Europe by morphologic subtype: results of the HAEMACARE project. Blood 2010; 116: 3724–3734.

  33. 33.

    , , , , , et al. Rare cancers are not so rare. Eur J Cancer 2011; 47: 2493–2511.

  34. 34.

    , , , , , et al. Twenty-five years of epidemiological recording on myeloid malignancies: data from the specialized registry of hematologic malignancies of Cote d’Or (Burgundy, France). Haematologica 2011; 96: 55–61.

  35. 35.

    , , , , , . Population-based incidence of myeloid malignancies: fifteen years of epidemiological data in the province of Girona, Spain. Haematologica 2013; 98: e95–e97.

  36. 36.

    Surveillance, Epidemiology, and End Results (SEER) Program () SEER*Stat Database: Incidence - SEER 18 Regs Research Data, November 2013 Sub (2000–2011) <Katrina/Rita Population Adjustment>, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2014, based on the November 2013 submission.

Download references


For the contribution to patients registration, data collection and follow-up we kindly acknowledge: Daniela Zackova, Brno, Hana Klamova, Prague and Jan Muzik, Brno, Czech Republic; Antonio de Vivo and Riccardo Ragionieri, Bologna, and Alessandra Cupi and Antonio Spitalieri, Catania, Italy; CM Kulikow and E Yu Chelysheva, Moscow, and Elza Lomaia, St. Petersburg, Russia; M Hoglund, Uppsala, Sweden; Luis-Felipe Casado, Toledo, and Pilar Giraldo, Zaragoza, Spain; Marzena Watek and Marek Dudzinsky, Krakow, and Witold Prejzner and Monika Szarejko, Gdansk, Poland; Florence Tartarin, Poirtiers, France; Barbara Braithwhite, Liverpool, UK; Violeta Milosevic and Olivera Markovic, Belgrade, Serbia; Tadas Zvirblis, Vilnius, Lithuania; Michael Ploetscher, Wels, Austria; Ingrida Udre, Riga, Latvia; Saara Vaalas and Minna Pajuportti, Helsinki, Finland; E Laane and Mary Punab, Tartu, Estonia; F Melanthiou and C Prokopiou, Cyprus; Yi Hao and Sandra Frank, Munich, Germany. The contribution of the investigators of other regions and countries is also acknowledged: Susanne Saussele, Mannheim, Germany; Andreas Hochhaus, Jena, Germany; Dimopoulos Panayiotidis, Athens, Greece; Tamasz Masszi, Budapest, Hungary; Antonio Medina Almeida, Lisboa, Portugal; Adriana Colita, Bucharest, Romania; Iryna Dyagil, Kyiv, Ukraina. The European Treatment and Outcome Study (EUTOS) is a project supported by Novartis Oncology Europe through a contract with European LeukemiaNet and the University of Heidelberg.

Author information

Author notes

    • V S Hoffmann
    •  & M Baccarani

    These authors contributed equally to this work.


  1. Institute for Medical Information Sciences, Biometry, and Epidemiology, Ludwig-Maximilians-Universitaet, Munich, Germany

    • V S Hoffmann
    • , J Hasford
    •  & D Lindoerfer
  2. Department of Hematology and Oncology L. and A., University of Bologna, Bologna, Italy

    • M Baccarani
  3. Department of Internal Medicine IV, Haematology and Oncology, Klinikum Wells-Grieskirchen, Wells, Austria

    • S Burgstaller
  4. Department of Medicine, Division of Hematology, University Hospital Center, Zagreb, Croatia

    • D Sertic
  5. The Karaiskakio Foundation, Nicosia, Cyprus

    • P Costeas
  6. Department of Internal Medicine – Hematooncology, Masaryk University Hospital, Brno, Czech Republic

    • J Mayer
  7. Department of Hematology-Oncology, University Hospital, Palacky University, Olomouc, Czech Republic

    • K Indrak
  8. Department of Hematology and Bone Marrow Transplantation, Tartu University Hospital, Tartu, Estonia

    • H Everaus
  9. Hematology Research Unit, Helsinki University Central Hospital and Hematology Research Unit, Biomedicum, Helsinki, Finland

    • P Koskenvesa
  10. INSERM CIC 1402, CHU, Poitiers, France

    • J Guilhot
  11. Munich Cancer Registry, Ludwig-Maximilians-Universitaet, Munich, Germany

    • G Schubert-Fritschle
  12. Department of Specialistic, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy

    • F Castagnetti
  13. Division of Hematology, Azienda Policlinico-OVE, University of Catania, Catania, Italy

    • F Di Raimondo
  14. National Hematology Centre, Riga Eastern Clinical University Hospital, Riga, Latvia

    • S Lejniece
  15. Vilnius University Hospital, Santariskiu Klinikos, Vilnius, Lithuania

    • L Griskevicius
  16. Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands

    • N Thielen
  17. Department of Hematology, Jagellonian University Hospital, Krakow, Poland

    • T Sacha
  18. Department of Hematology and Transplantation, Medical University of Gdansk, Gdansk, Poland

    • A Hellmann
  19. FSBI Hematology Research Center of Healthcare Ministry of Russian Federation, Moscow, Russia

    • A G Turkina
  20. Institute of Hematology, St. Petersburg State Medical University, St. Petersburg, Russian Federation

    • A Zaritskey
  21. Institut za Haematologiju, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia

    • A Bogdanovic
  22. Department of Hematology, University Hospital, Bratislava, Slovakia

    • Z Sninska
  23. Department of Hematology, University Clinical Centre, Ljubljana, Slovenia

    • I Zupan
  24. Hematology & Research Institute, Hospital de la Princesa, Madrid, Spain

    • J-L Steegmann
  25. Department of Internal Medicine, University of Uppsala, Uppsala, Sweden

    • B Simonsson
  26. Institute of Translational Medicine, Royal Liverpool University Hospital, Liverpool, UK

    • R E Clark
  27. Novartis Oncology Europe, Origgio, Italy

    • A Covelli
    •  & G Guidi
  28. III. Medizinische Klinik, University of Heidelberg in Mannheim, Mannheim, Germany

    • R Hehlmann


  1. Search for V S Hoffmann in:

  2. Search for M Baccarani in:

  3. Search for J Hasford in:

  4. Search for D Lindoerfer in:

  5. Search for S Burgstaller in:

  6. Search for D Sertic in:

  7. Search for P Costeas in:

  8. Search for J Mayer in:

  9. Search for K Indrak in:

  10. Search for H Everaus in:

  11. Search for P Koskenvesa in:

  12. Search for J Guilhot in:

  13. Search for G Schubert-Fritschle in:

  14. Search for F Castagnetti in:

  15. Search for F Di Raimondo in:

  16. Search for S Lejniece in:

  17. Search for L Griskevicius in:

  18. Search for N Thielen in:

  19. Search for T Sacha in:

  20. Search for A Hellmann in:

  21. Search for A G Turkina in:

  22. Search for A Zaritskey in:

  23. Search for A Bogdanovic in:

  24. Search for Z Sninska in:

  25. Search for I Zupan in:

  26. Search for J-L Steegmann in:

  27. Search for B Simonsson in:

  28. Search for R E Clark in:

  29. Search for A Covelli in:

  30. Search for G Guidi in:

  31. Search for R Hehlmann in:

Competing interests

VSH, MB, JH and DL receive research funding from Novartis. NT and ZS have a consulting or advisory role at Novartis. AC and GG are employed by Novartis. KI has a consulting or advisory role at Amgen and Novartis. BS has a consulting or advisory role at BMS. AB receives funding of travel, accommodations or expenses from Novartis Oncology, Serbia. RH receives honoraria from BMS and research funding from Novartis and BMS. SB receives honoraria from Novartis, Celgene and AOP, has a consulting or advisory role at Novartis and Celgene, and receives funding of travel, accommodations or expenses from Novartis and AOP. AGT and JM have a consulting or advisory role at Novartis and BMS, and JM receives research funding and funding of travel, accommodations or expenses from Novartis and BMS. AZ has a consulting or advisory role at and participated in a speakers’ bureau for Novartis and received research funding from BMS. LG receives research funding from Novartis and Roche and funding of travel, accommodations, or expenses from Novartis, Roche and Takeda. PK has a consulting or advisory role at GSK, BMS and Novartis, receives funding from Novartis, provides expert testimony for Pfizer and Novartis, and receives funding of travel, accommodations or expenses from BMS and Ariad. FR receives honoraria from BMS and Novartis, has a consulting or advisory role at BMS and Ariad, participated in a speakers’ bureau for BMS and Novartis, and receives research funding from BMS. AH participated in a speakers’ bureau for Novartis and BMS, receives research funding and funding of travel, accommodations or expenses from Novartis and BMS, and provides expert testimony for Novartis and BMS. FC has a consulting or advisory role and receives honoraria and funding of travel, accommodations or expenses from Novartis and BMS. TS has a consulting or advisory role at, participated in a speakers’ bureau for and receives honoraria from Novartis, BMS, ADAMED and receives research funding and funding of travel, accommodations or expenses from Novartis and BMS. JLS has a consulting or advisory role at and receives honoraria and research funding from BMS, Novartis and Pfizer, and funding of travel, accommodations or expenses from BMS and Novartis. REC participated in a speakers’ bureau for Novartis, receives funding from and has a consulting or advisory role at Novartis, BMS, Pfizer and Sanofi, and receives honoraria from Novartis, BMS, Pfizer, Sanofi and TEVA. The remaining authors declare no conflict of interests.

Corresponding author

Correspondence to V S Hoffmann.

About this article

Publication history







Further reading