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Meta-Analysis
. 2025 Jun 2;15(1):19282.
doi: 10.1038/s41598-025-95356-5.

Survival outcomes in secondary and primary acute lymphoblastic leukemia: a systematic review and meta-analysis

Fatemeh Abedini #  1   2 , Amirreza Manteghinejad #  2 , Zahra Rezaeian  2 , Soraya Masoudi  2 , Saeedeh Salehi  3 , Ali Samankan  4 , Fariba Dehghan  5 , Azadeh Khalvandi  6 , Atefeh Vaezi  2 , Mehran Sharifi  7   8
Affiliations
Meta-Analysis

Survival outcomes in secondary and primary acute lymphoblastic leukemia: a systematic review and meta-analysis

Fatemeh Abedini et al. Sci Rep. .

Abstract

This systematic review and meta-analysis aimed to compare the survival outcomes and cytogenetic profile of primary acute lymphoblastic leukemia (p-ALL) and secondary ALL (s-ALL), including antecedent-malignancy ALL (am-ALL) and therapy-related ALL (tr-ALL). The search was performed in PubMed/MEDLINE, Scopus, Web of Science, Embase, and ProQuest databases from January 1, 1990, to July 31, 2023, using the keywords "acute lymphoblastic leukemia" and "second cancer" to identify cohort studies that compared p-ALL and s-ALL in terms of survival outcomes and cytogenetic profile. The risk of bias in the included studies was assessed using the Joanna Briggs Institute (JBI) for Cohort Studies. A total of 7 studies involving 13,542 participants were analyzed. The results revealed an HR of 2.35 (95%CI:1.38-4.01) for overall survival (OS) and 2.06 (95%CI:1.05-4.06) for relapse-free survival (RFS). Subgroup analysis of tr-ALL patients showed a significantly higher HR of 3.40 (95%CI:2.32-4.99) for OS in this subgroup. Furthermore, the meta-analysis indicated an OR of 3.45 and 5.90 for mixed lineage rearrangement (MLL) and hypodiploidy, respectively. The study highlights the need for a better understanding of the survival rates and cytogenetic profile of secondary ALL, particularly tr-ALL, and the importance of personalized treatment strategies for this subtype.

Keywords: Antecedent Malignancy ALL (am-ALL); Primary acute lymphoblastic leukemia (p-ALL); Secondary ALL (s-ALL); Therapy-related ALL (tr-ALL).

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics approval: This study was approved by the ethics committee of Isfahan University of Medical Science. (Ethics Code: IR.ARI.MUI.REC.1401.104).

Figures

Fig. 1
Fig. 1
PRISMA 2020 flow diagram.
Fig. 2
Fig. 2
Forest plots for overall survival (a), adjusted overall survival (b), relapse-free survival (c), and subgroup analysis based on type of comparison (d).
Fig. 3
Fig. 3
Meta-regression to evaluate relationship between hazard ratio and follow-up time.
See this image and copyright information in PMC

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