Diagnostic and Prognostic Bone Marrow Findings in Pediatric Leukemia: A Systematic Review and Meta-Analysis

Background: Pediatric leukemia is the most common childhood malignancy, and bone marrow examination remains central to its diagnosis and prognostication. However, variability exists in reported marrow findings across studies.

Objective: To systematically evaluate diagnostic and prognostic bone marrow findings in pediatric leukemia.

Methods: A systematic review and meta-analysis of studies published between 2000 and 2025 was conducted following PRISMA guidelines. Databases searched included PubMed, Scopus, Web of Science, and Google Scholar. Studies involving pediatric leukemia with reported bone marrow findings were included. Data were pooled using a random-effects model.

Results: A total of 38 studies with 5,462 pediatric patients were included. Acute lymphoblastic leukemia (ALL) was the most common subtype (72%), followed by acute myeloid leukemia (AML) (24%). Hypercellular marrow (92%) and blast predominance (>25% blasts in 89%) were the most consistent findings. B-cell lineage predominated (65%). Common cytogenetic abnormalities included t(12;21) (favorable prognosis) and t(9;22) (poor prognosis). Key prognostic factors included blast percentage, cytogenetics, immunophenotype, and minimal residual disease (MRD).

Conclusion: Bone marrow evaluation integrating morphology, immunophenotyping, and cytogenetics is essential for accurate diagnosis and prognostic stratification in pediatric leukemia. Standardization of diagnostic approaches and incorporation of molecular techniques may further improve clinical outcomes.