Abedini Fatemeh, Manteghinejad Amirreza, Rezaeian Zahra, Masoudi Soraya, Salehi Saeedeh, Samankan Ali, Dehghan Fariba, Khalvandi Azadeh, Vaezi Atefeh, Sharifi Mehran
Core Research Facilities (CRF), Isfahan University of Medical Sciences, Isfahan, Iran.
Cancer Prevention Research Center, Omid Hospital, Isfahan University of Medical Sciences, Mottahari St, Isfahan, Iran.
Sci Rep. 2025 Jun 2;15(1):19282. doi: 10.1038/s41598-025-95356-5.
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.
本系统评价和荟萃分析旨在比较原发性急性淋巴细胞白血病（p-ALL）和继发性急性淋巴细胞白血病（s-ALL，包括既往恶性肿瘤相关性急性淋巴细胞白血病（am-ALL）和治疗相关性急性淋巴细胞白血病（tr-ALL））的生存结局和细胞遗传学特征。检索了1990年1月1日至2023年7月31日期间的PubMed/MEDLINE、Scopus、Web of Science、Embase和ProQuest数据库，使用关键词“急性淋巴细胞白血病”和“第二癌症”来识别比较p-ALL和s-ALL生存结局和细胞遗传学特征的队列研究。采用乔安娜·布里格斯研究所（JBI）队列研究偏倚风险评估工具对纳入研究的偏倚风险进行评估。共分析了7项研究，涉及13542名参与者。结果显示，总生存（OS）的风险比（HR）为2.35（95%置信区间：1.38 - 4.01），无复发生存（RFS）的HR为2.06（95%置信区间：1.05 - 4.06）。tr-ALL患者的亚组分析显示，该亚组OS的HR显著更高，为3.40（95%置信区间：2.32 - 4.99）。此外，荟萃分析表明，混合谱系重排（MLL）和亚二倍体的比值比（OR）分别为3.45和5.90。该研究强调了更好地了解继发性急性淋巴细胞白血病，特别是tr-ALL的生存率和细胞遗传学特征的必要性，以及针对该亚型采用个性化治疗策略的重要性。
