Real-World Outcomes of Total Body Irradiation versus Chemotherapy-Based Conditioning in Pediatric Acute Lymphoblastic Leukemia

Purpose

To compare outcomes after total body irradiation (TBI)-based and chemotherapy-based conditioning in pediatric acute lymphoblastic leukemia (ALL). Patients and methods: This retrospective two-center PeARL registry cohort comprised 325 patients diagnosed with ALL at age ≤18 years who underwent first allogeneic hematopoietic stem cell transplantation during 2009-2023. Primary Cox and Fine-Gray models used full follow-up, adjusted for transplantation age, remission status and donor type, and were stratified by center. Propensity-score weighting was supplementary. Graft-versus-host disease (GVHD) analyses excluded recorded cases with unavailable or inconsistent onset dates and accounted for competing relapse and death; acute GVHD included any or unspecified grade.