Allogeneic hematopoietic cell transplantation is equally effective in secondary acute lymphoblastic leukemia (ALL) compared to de-novo ALL—a report from the EBMT registry

Secondary acute lymphoblastic leukemia (s-ALL) comprises up to 10% of ALL patients. However, data regarding s-ALL outcomes is limited. To answer what is the role of allogeneic hematopoietic

cell transplantation (HCT) in s-ALL, a matched-pair analysis in a 1:2 ratio was conducted to compare outcomes between s-ALL and de novo ALL (dn-ALL) patients reported between 2000–2021 to

the European Society for Blood and Marrow Transplantation registry. Among 9720 ALL patients, 351 (3.6%) were s-ALL, of which 80 were in first complete remission (CR1) with a known precedent

primary diagnosis 58.8% solid tumor (ST), 41.2% hematological diseases (HD). The estimated 2-year relapse incidence (RI) was 19.1% (95%CI: 11–28.9), leukemia-free survival (LFS) 52.1%

(95%CI: 39.6–63.2), non-relapse mortality (NRM) 28.8% (95%CI: 18.4–40), GvHD-free, relapse-free survival (GRFS) 39.4% (95%CI: 27.8–50.7), and overall survival (OS) 60.8% (95%CI: 47.9–71.4),

and did not differ between ST and HD patients. In a matched-pair analysis, there was no difference in RI, GRFS, NRM, LFS, or OS between s-ALL and dn-ALL except for a higher incidence of

chronic GvHD (51.9% vs. 31.4%) in s-ALL. To conclude, patients with s-ALL who received HCT in CR1 have comparable outcomes to patients with dn-ALL.

ASK, JMZ, ML, and MM had full access to all study data (available upon data-specific request).

ASK wrote the manuscript, designed the study, and interpreted the data. JMZ and MM designed the study, interpreted the data, and edited the manuscript. ML designed the study, performed the

statistical analyses, interpreted the data, and edited the manuscript. JHB, DB, IYA, US, JP, NF, TS, SG, EB, and FC reviewed the manuscript and provided clinical data. All authors approved

the final version of the manuscript.

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