Secondary acute lymphoblastic leukemia is an independent predictor of poor prognosis

• Cases of secondary acute lymphoblastic leukemia (sALL) and de novo ALL were compared.
• sALL is associated with worse overall survival.
• Increasing age at diagnosis of sALL is also associated with worsened survival.
• sALL is an independent risk factor for poor prognosis by multivariate analysis.

Compared to secondary acute myeloid leukemia, secondary acute lymphoblastic leukemia (sALL) is poorly characterized. We utilized data from the Surveillance, Epidemiology, and End Results (SEER) 13 database to further elucidate patient characteristics and prognostic factors in sALL. Cases of adult de novo acute lymphoblastic leukemia (ALL) and sALL in patients with primary breast, rectum, cervix, or ovarian cancers or lymphoma with a latency period of at least 12 months were identified within the SEER 13 database. Survival in sALL and de novo ALL were compared after propensity matching based on age, gender, race, ALL subtype, and year of diagnosis. 4124 cases of de novo ALL and 79 cases of sALL were identified. sALL patients were older at diagnosis (median 62 years vs 44 years; p < 0.01). Overall survival (OS) in sALL was lower than de novo ALL (median 8 months vs 11 months), 1 year OS: 35% vs 47% (p = 0.05), 2 year OS: 16% vs 31% (p < 0.01), and 5 year OS: 7% vs 21% (p < 0.01). Multivariate analysis revealed sALL as an independent predictor of worsened survival (adjusted HR 1.54; 95% CI 1.16-2.04, p < 0.01) after propensity matching.