Although most children with acute lymphoblastic leukemia (ALL) receive fractionated total body irradiation (FTBI) as myeloablative conditioning (MAC) for allogeneic hematopoietic stem cell transplantation (allo-HSCT), it is an important matter of debate if chemotherapy can effectively replace FTBI. To compare outcomes after FTBI versus chemotherapy-based conditioning (CC), we performed a retrospective EBMT registry study. Children aged 2-18 years after MAC for first allo-HSCT of bone marrow (BM) or peripheral blood stem cells (PBSC) from matched-related (MRD) or unrelated donors (UD) in first (CR1) or second remission (CR2) between 2000 and 2012 were included. Propensity score weighting was used to control pretreatment imbalances of the observed variables. 3.054 patients were analyzed. CR1 (1.498): median follow-up (FU) after FTBI (1.285) and CC (213) was 6.8 and 6.1 years. Survivals were not significantly different. CR2 (1.556): median FU after FTBI (1.345) and CC (211) was 6.2 years. Outcomes after FTBI were superior as compared with CC with regard to overall survival (OS), leukemia-free survival (LFS), relapse incidence (RI), and nonrelapse mortality (NRM). However, we must emphasize the preliminary character of the results of this retrospective "real-world-practice" study. These findings will be prospectively assessed in the ALL SCTped 2012 FORUM trial.

BMT Department Russian Children's Hospital Moscow Russia

BMT Unit Department of Pediatric Hematology and Oncology Comenius University Medical School Limbová Bratislava Slovak Republic

BMT Unit University Medical Centre Utrecht Pediatrics Utrecht The Netherlands

Bone Marrow Transplant Program Instituto Portugues Oncologia Lisbon Portugal

Bone Marrow Transplantation Service Portuguese Institute of Oncology Porto Portugal

Bone Marrow Transplantation Unit Pediatric Department of Milano Bicocca University Fondazione Monza e Brianza per il Bambino e la sua Mamma Foundation Monza Italy

Center of Pediatric Oncology and Hematology Vilnius University Vilnius Lithuania

Centre Pierre et Marie Curie Service Hématologie Greffe de Moelle Alger Algeria

Department for Pediatric Hematology and Hemopoietic Stem Cell Transplantation Central Hospital of Southern Pest National Institute of Hematology and Infectious Diseases United St Istvan and St László Hospital Budapest Hungary

Department of Bone Marrow Transplantation Hadassah Hebrew University Medical Center Jerusalem Israel

Department of Bone Marrow Transplantation Oncology and Hematology Cape of Hope Medical Center Wroclaw Medical University Wroclaw Poland

Department of Haematology Internal Clinic University Hospital Centre Zagreb Croatia

Department of Hematology Child Welfare Center Borsod County Teaching Hospital Miskolc Hungary

Department of Pediatric Hemato Immunology Hôpital Robert Debré and Université de Paris Paris France

Department of Pediatric Hematology and BMT IHOP and Claude Bernard University Lyon France

Department of Pediatric Hematology and Oncology and Research Unit EA 3279 Timone Enfants Hospital AP HM and Aix Marseille University Marseille France

Department of Pediatric Hematology and Oncology Cliniques Universitaires Saint Luc Brussels Belgium

Department of Pediatric Hematology and Oncology Collegium Medicum Nicolaus Copernicus University Torun Bydgoszcz Poland

Department of Pediatric Hematology and Oncology Oslo University Hospital Oslo Norway

Department of Pediatric Hematology and Oncology University Hospital Motol Prague Czech Republic

Department of Pediatric Hematology and Stem Cell Transplantation Unit Medicalpark Antalya Hastanesi Antalya Turkey

Department of Pediatric Hematology Oncology and Stem Cell Transplantation University of Regensburg Regensburg Germany

Department of Pediatric Hematology Oncology King Faisal Specialist Hospital and Research Center Riyadh Saudi Arabia

Department of Pediatric Hematology Oncology School of Medicine Akdeniz University Antalya Turkey

Department of Pediatric Oncology Hematology and Transplantology University of Medical Sciences Poznan Poland

Department of Pediatrics Copenhagen University Hospital Rigshospitalet Copenhagen Denmark

Department of Pediatrics Leiden University Medical Center Leiden The Netherlands

Department of Pediatrics Onco Hematology Unit Geneva University Hospital Geneva University Geneva Switzerland

Dipartimento di Onco Ematologia e Terapia Cellulare e Genica IRCCS Ospedale Pediatrico Bambino Gesù Rome Italy

Dipartimento Materno Infantile e Scienze Urologiche Sapienza University of Rome Rome Italy

Division for Stem Cell Transplantation and Immunology Department for Children and Adolescents University Hospital Goethe University Frankfurt Frankfurt Germany

Division of Pediatrics CLINTEC Karolinska Institutet and Pediatric Hematology Immunology and HCT Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden

Division of Stem Cell Transplantation and Regenerative Medicine Department of Pediatrics School of Medicine Stanford University Stanford CA USA

Division of Stem Cell Transplantation Children's Research Center University Children's Hospital Zurich Switzerland

EBMT Paediatric Diseases Working Party Paris France

EBMT Paris Study Office Paris France

Great Ormond Street Hospital for Children NHS Foundation Trust London UK

Hematology Oncology and BMT Research Shariati Hospital Tehran Iran

Hematology Oncology Unit Lalla Seràgnoli Department of Pediatrics University of Bologna Bologna Italy

Hospital for Children and Adolescents University of Helsinki Helsinki Finland

Paediatric Onco Haematology City of Science and Health of Turino Regina Margherita Children's Hospital Torino Italy

Pediatric Cell Therapy Research Center Tehran University of Medical Sciences Tehran Iran

Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology Haematology and Transplantation Saint Petersburg State Medical 1 P Pavlov University Saint Petersburg Russia

Republic Clinical Research Centre for Pediatric Oncology and Hematology Minsk Belarus

Servicio de Hematologia y Oncologia Pediátricas Hospital Universitario Vall d'Hebron Barcelona Spain

St Anna Children's Hospital Department of Pediatrics Medical University of Vienna Vienna Austria

Stem Cell Transplant Unit Aghia Sophia Children's Hospital Thivon and Papadiamantopoulou Athens Greece

Tartu University Hospital Tartu Estonia

University Hospitals Bristol NHS Foundation Trust Bristol UK

Bone Marrow Transplant. 2021 Oct;56(10):2615. doi: 10.1038/s41409-021-01424-5. PubMed

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