Acute lymphoblastic leukemia (ALL) is the number one cancer in children worldwide. Survival with ALL in children has shown a steady improvement over time with contemporary chemotherapy. This study aimed to determine the incidence rates and lifetime health impacts of pediatric ALL in Taiwan. A total of 3,854 patients with the diagnosis of ALL (ICD-9-CM code: 2040) were collected from the Registry for Catastrophic Illness (RCI) between 1997 and 2015 to assure the diagnostic accuracy. We included 2,044 cases for the final analysis. All patients were followed-up until the end of 2017 by linkage with the National Mortality Registry of Taiwan. A survival extrapolation method was applied and validated to estimate the lifetime survival function for life expectancy (LE) and loss-of-life expectancy (loss-of-life LE). The cohort included 1,222 males and 822 females. The average incidence rates (IRs) of pediatric ALL from 1997 to 2015 for age strata of <1, 1-4, 5-9, 10-14, 15-18 were 1.24, 3.39, 2.21, 1.56, and 0.97 per 100,000 person-year, respectively. The cumulative incidence rate up to age 18 (CIR0-18) of pediatric ALL increased after 2001, and was more pronounced in males than females. Most patients received treatments based on the protocol of Taiwan pediatric oncology group (TPOG)-ALL-97 (23.0%) or TPOG-ALL-2002 (62.7%). After extrapolation of survival to age 80, we found LE and loss-of-LE of pediatric ALL were 54.5 and 15.2 years, respectively. Future studies should explore long-term survival for different groups at risk of pediatric ALL and impacts of ALL on the society.

Genetic changes in juvenile myelomonocytic leukemia (JMML) determine distinct subtypes, treatments and outcomes. JMML with germline CBL mutation and somatic NRAS mutation possibly achieves spontaneous remission, but hematopoietic stem cell transplantation is indicated for other subtypes of JMML. We hereby report a child with JMML harboring a germline CBL mutation (c.1111T>C) and an NF1 variant (c.3352A>G) concurrently. After evaluation, we considered the NF1 variant not the major contributor. After one year of observation, this case had no signs of disease progression. This case highlights the importance of combining available evidence and clinical findings in caring patients with unusual genomic variations.