Incidence of subsequent malignancies after total body irradiation-based allogeneic HSCT in children with ALL – long-term follow-up from the prospective ALL-SCT 2003 trial

• DOI: 10.1038/s41375-022-01693-z
• Publication Date: 2022-09-12T18:03:55Z
• Authors: Anna Eichinger; Ulrike Poetschger; Evgenia Glogova; Peter Bader; Oliver Basu; Rita Beier; Birgit Burkhardt; Carl-Friedrich Cl...; Alexander Claviez; Selim Corbacioglu; Hedwig E. Deubzer; Johann Greil; Bernd Gruhn; Tayfun Güngör; Kinan Kafa; Jörn-Sven Kühl; Peter Lang; Bjoern Soenke Lange; Roland Meisel; Ingo Müller; Martin G. Sauer; Paul-Gerhardt Sch...; Ansgar Schulz; Daniel Stachel; Brigitte Strahm; Angela Wawer; Christina Peters; Michael H. Albert
• Keywords: Total body irradiation

Abstract Total body irradiation (TBI)-based conditioning is associated with superior leukemia-free survival in children ALL undergoing HSCT. However, the risk for subsequent malignant neoplasms (SMN) remains a significant concern. We analyzed 705 pediatric patients enrolled prospective ALL-SCT-BFM-2003 trial and its registry. Patients >2 years received TBI 12 Gy/etoposide ( n = 558) ≤2 of age or contraindications busulfan/cyclophosphamide/etoposide 110). The 5- 10-year cumulative incidence SMN was 0.02 ± 0.01 0.13 0.03, respectively. In total, 39 (34 solid tumors, 5 MDS/AML) were diagnosed 33 at median 5.8 (1.7–13.4), exclusively group. Of affected patients, 21 (64%) are alive follow-up 5.1 (0–9.9) after diagnosis their first SMN. univariate analysis, neither HSCT, donor type, acute GVHD, chronic nor CMV constituted factor only versus non-TBI based conditioning. This analysis confirms quantifies increased TBI. Future strategies to avoid will need careful tailoring within prospective, controlled studies prevent unfavorable outcomes.