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Summary  We report a comparative analysis of patients with therapy‐related acute lymphoblastic leukaemia (tr‐ALL) vs  de novo  ALL. We identified 331 patients with B‐ALL; 69 (21%) were classified as tr‐ALL. The most common prior malignancies were breast (23·2%) and plasma cell disorders (20·3%). Patients with tr‐ALL were older (median 63·2 vs. 46·2 years,  P  < 0.001), more often female (66·7% vs. 43·5%,  P  < 0·001), and more likely to have hypodiploid cytogenetics (18·8% vs. 5·0%,  P  < 0·001). In multivariable analysis, patients with tr‐ALL were less likely to achieve complete remission [odds ratio (OR) = 0·16,  P  < 0·001] and more likely to be minimal residual disease‐positive (OR = 4·86,  P  = 0·01) but had similar OS after diagnosis and allo‐haematopoietic cell transplantation.

Comparative study of therapy‐related and de novo adult b‐cell acute lymphoblastic leukaemia