Cumulative risk of a second malignant neoplasm (SMN) by risk group for patients who did not receive a transplant in first remission. Standard risk (SR) was 2.4% ± 0.7%, intermediate risk (IR) was 1.2% ± 0.7%, and higher risk (HR) was 0.3% ± 0.3% (P = .007). ALL indicates acute lymphoblastic leukemia.