A Bibliometric Analysis of Drug Resistance in Pediatric Acute Lymphoblastic Leukemia.

Background: Despite the improved outcomes in acute lymphoblastic leukemia (ALL), drug resistance remains a major challenge. This study provides the first overview of global research trends in pediatric ALL drug resistance, highlighting emerging directions. Materials and Methods: In this bibliometric study, related keywords such as acute lymphoblastic leukemia, pediatric, and drug resistance were searched in the Web of Science (WOS) Core Collection. The retrieved papers were subjected to bibliometric analysis and visualization using Biblioshiny and VOSviewer. Results: A total of 432 original papers and 94 review articles by 2546 researchers from 48 countries were analyzed. The United States contributed 148 articles, which received 9569 citations. Bradford's law identified nine core sources, with Blood being the most impactful (41 papers and 4900 total citations). "Oncology" was the top WOS category. Pieters was the most influential author, contributing 87 publications in the field. The most frequent keywords highlighted the biological contributors to drug resistance, including altered glucocorticoid response, overexpression of drug-efflux proteins (particularly P-gp), and the critical role of miRNAs and other genetic mediators in leukemic cell drug resistance. Based on the thematic map, the keywords of the motor themes were clofarabine, nelarabine, daunorubicin, vincristine, and microRNA, illustrating the need for further investigation of their clinical applications and the underlying mechanisms of resistance to these agents. Conclusion: Medical researchers have been attracted to different aspects of drug resistance in pediatric ALL. This bibliometric analysis reflects the current state of research on drug resistance in pediatric ALL and draws attention to critical concerns that require further investigation.