Reduced‐dose versus standard‐dose total body irradiation before allogeneic haematopoietic stem cell transplantation in adults with acute lymphoblastic leukaemia
- 1Department of Radiation Oncology University Hospital Regensburg Regensburg Germany
- 2Department of Internal Medicine III University Hospital Regensburg Regensburg Germany
- 3Leibniz Institute for Immunotherapy Regensburg Germany
Abstract
Comparative data on reduced‐dose (8 Gy) versus standard‐dose (12 Gy) total body irradiation (TBI) before allogeneic haematopoietic stem cell transplantation (allo‐HSCT) for adults with acute lymphoblastic leukaemia (ALL) remain limited. We retrospectively analysed 101 adults undergoing first allo‐HSCT between 1999 and 2024 after 8 Gy or 12 Gy fractionated TBI‐based conditioning. Relapse and non‐relapse mortality (NRM) were analysed using multivariable Fine–Gray models. Median follow‐up was 8.1 years. Although the 8 Gy cohort was older, had greater comorbidity burden and a higher‐risk disease profile, unadjusted NRM, relapse incidence and overall survival did not differ between groups. In multivariable analyses, 12 Gy TBI was associated with increased NRM (sub‐distribution hazard ratio 5.97, 95% confidence interval [CI] 1.77–20.15; p = 0.004) without evidence of reduced relapse incidence. The association between 12 Gy TBI and higher NRM was consistent across sensitivity analyses, including adjustment for transplant year and conditioning regimen, cause‐specific Cox regression and propensity score overlap weighting. The association of 12 Gy TBI with inferior overall survival in the multivariable model was not confirmed after overlap weighting. Consistent pre‐transplant measurable residual disease data were unavailable, limiting adjustment for this prognostic factor. These findings support prospective evaluation of reduced‐dose TBI in selected adults with ALL.
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BibTeX
@article{gruber2026reduceddose,
title = {{Reduced‐dose versus standard‐dose total body irradiation before allogeneic haematopoietic stem cell transplantation in adults with acute lymphoblastic leukaemia}},
author = {Isabella Gruber and Matthias Edinger and Hendrik Poeck and Elisabeth Meedt and Ernst Holler and Wolfgang Herr and Oliver Koelbl and Daniel Wolff},
journal = {British Journal of Haematology},
year = {2026},
month = sep,
doi = {10.1111/bjh.70835},
url = {https://doi.org/10.1111/bjh.70835},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Reduced‐dose versus standard‐dose total body irradiation before allogeneic haematopoietic stem cell transplantation in adults with acute lymphoblastic leukaemia
AU - Isabella Gruber
AU - Matthias Edinger
AU - Hendrik Poeck
AU - Elisabeth Meedt
AU - Ernst Holler
AU - Wolfgang Herr
AU - Oliver Koelbl
AU - Daniel Wolff
PY - 2026
DA - 2026/09/15
JO - British Journal of Haematology
DO - 10.1111/bjh.70835
UR - https://doi.org/10.1111/bjh.70835
AB - Comparative data on reduced‐dose (8 Gy) versus standard‐dose (12 Gy) total body irradiation (TBI) before allogeneic haematopoietic stem cell transplantation (allo‐HSCT) for adults with acute lymphoblastic leukaemia (ALL) remain limited. We retrospectively analysed 101 adults undergoing first allo‐HSCT between 1999 and 2024 after 8 Gy or 12 Gy fractionated TBI‐based conditioning. Relapse and non‐relapse mortality (NRM) were analysed using multivariable Fine–Gray models. Median follow‐up was 8.1 years. Although the 8 Gy cohort was older, had greater comorbidity burden and a higher‐risk disease profile, unadjusted NRM, relapse incidence and overall survival did not differ between groups. In multivariable analyses, 12 Gy TBI was associated with increased NRM (sub‐distribution hazard ratio 5.97, 95% confidence interval [CI] 1.77–20.15; p = 0.004) without evidence of reduced relapse incidence. The association between 12 Gy TBI and higher NRM was consistent across sensitivity analyses, including adjustment for transplant year and conditioning regimen, cause‐specific Cox regression and propensity score overlap weighting. The association of 12 Gy TBI with inferior overall survival in the multivariable model was not confirmed after overlap weighting. Consistent pre‐transplant measurable residual disease data were unavailable, limiting adjustment for this prognostic factor. These findings support prospective evaluation of reduced‐dose TBI in selected adults with ALL.
SN - 0007-1048
SN - 1365-2141
ER -