ArticleClinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico2026
Total body irradiation-based conditioning in allogeneic transplantation in patients with hematological malignancies: impact in outcomes by stem-cell source.
Article in Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTotal body irradiation is widely used in conditioning regimens before allogeneic hematopoietic stem-cell transplantation (allo-HSCT), most often in high-risk acute lymphoblastic leukemia. This study assessed survival outcomes and treatment-related toxicity in patients who underwent TBI-based myeloablative conditioning.
methodsWe conducted a retrospective single-center study of patients who underwent allo-HSCT after TBI-based conditioning at a reference TBI-unit serving transplant across the Community of Madrid. Between 2011 and 2020, most patients (n = 52) received 10 Gy in 2 Gy fractions twice daily. Primary endpoints were overall survival (OS), disease-free survival (DFS), and relapse; secondary endpoints included non-relapse mortality (NRM), disease-related mortality (DRM), and toxicity.
results58 patients underwent TBI-based conditioning using peripheral blood stem cells (PBSC; n = 37), umbilical cord blood (UCB; n = 19), or bone marrow (BM; n = 1); one patient died before graft infusion. Diagnoses were B-ALL (79.3%), followed by T-ALL (15.5%), non-Hodgkin lymphoma (3.4%), and acute myeloid leukemia (1.7%). Median follow-up was 28 months. At 12 months, OS, DFS, and relapse were 64%, 48%, and 29%, respectively. PBSC transplantation had significantly higher 12-month OS than UCB (78% vs. 37%, p < 0.001). Six-month NRM was 5% and 8% in PBSC recipients vs. 43% and 54% in UCB (p < 0.001). Graft-versus-host disease occurred in 51.7%, pulmonary complications in 32.8%, and neurological toxicity in 25.9%. Secondary malignancies were reported in four patients.
conclusionTBI-based conditioning achieved acceptable outcomes in PBSC recipients but was associated with markedly higher NRM in UCB recipients. These findings highlight graft source as a critical determinant of survival and support individualized strategies in allo-HSCT.
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