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August 23, 2026LeukemiaOpen Access

Total body irradiation versus chemotherapy before stem cell transplantation in children aged two to four with acute lymphoblastic leukemia—an EBMT pediatric diseases working party study

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Authors

AEAnna EichingerZSZofia SzmitKKKatharina Kleinschmidt

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Overview

Retrospective cohort study finds TBI improves survival and leukemia control over chemotherapy in toddlers with ALL, suggesting its ongoing value despite higher secondary cancer risks.

Key Points

  • To evaluate leukemia control, overall survival, and subsequent malignant neoplasm incidence after TBI- versus chemotherapy-based conditioning in children aged 2 to 4 years undergoing alloHSCT for ALL.
  • Retrospective multicenter EBMT registry study of 280 children aged 2–4 with ALL in complete remission who received first alloHSCT between 2000 and 2012.
  • Compared myeloablative TBI-based conditioning (n=161, 57.5%) with chemotherapy-based conditioning (n=119, 42.5%) over a median follow-up of 13.2 years.
  • TBI-based conditioning produced superior 10-year overall survival (68.1% vs. 50.7%; multivariable HR 1.77, 95% CI 1.19–2.63, p=0.005) and reduced 10-year relapse incidence (22.4% vs. 41.5%; HR 2.31, 95% CI 1.48–3.61, p<0.001).
  • Chemotherapy-based conditioning showed inferior 10-year leukemia-free survival (44.0% vs. 64.4%; HR 1.92, 95% CI 1.33–2.77, p<0.001) and lower 13-year refined GRFS (32.5% vs. 47.1%; HR 1.54, 95% CI 1.11–2.13, p=0.009).
  • The 13-year cumulative incidence of subsequent malignant neoplasms was higher after TBI (9.7%) than chemotherapy (1.8%), with a significantly longer median latency (8.5 vs. 1.6 years, p<0.001).

Cite This Study

Eichinger et al. (2026) studied this question.

synapsesocial.com/papers/6a8aae007677a34114446a7ehttps://doi.org/10.1038/s41375-026-03114-x
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Total body irradiation-based conditioning in allogeneic transplantation in patients with hematological malignancies: impact in outcomes by stem-cell source2026
  2. 2Reduced intensity conditioning with 8 Gy total body irradiation in adult patients with acute lymphoblastic leukemia2025 · 3 citations
  3. 3Impact of conditioning regimen on outcomes of adolescents and young adults AML patients undergoing HCT in complete remission, with transplant conditioning intensity score of 3.5-4.0. a study from the acute leukemia working party of the european society for blood and marrow transplantation.2025 · 1 citations
  4. 4Reduced‐dose versus standard‐dose total body irradiation before allogeneic haematopoietic stem cell transplantation in adults with acute lymphoblastic leukaemia2026
  5. 5Late effects following HSCT for childhood ALL: A national single‐center study using three different modalities of delivery of total body irradiation2024