Reduced-intensity conditioning is widely used with hematopoietic stem cell transplantation for non-malignant diseases: however, the optimal conditioning to ensure stable engraftment has not been established. In this study, we retrospectively compared the impact of low-dose (1–6 Gy) irradiation and in vivo T-cell depletion on the clinical outcome of 523 patients with non-malignant disease who underwent a first allogeneic hematopoietic stem cell transplantation using fludarabine-based reduced-intensity conditioning. Use of low-dose irradiation, but not of anti-thymocyte globulin/anti-lymphocyte globulin, showed a beneficial effect on overall survival (adjusted hazard ratio: 0.56; 95% confidence interval: 0.35–0.91, P = 0.018). Furthermore, use of low-dose irradiation was strongly associated with lower transplant-related mortality (adjusted hazard ratio: 0.55; 95% confidence interval: 0.32–0.96, P = 0.034). The addition of low-dose irradiation to the conditioning regimen was beneficial, at least to the short-term clinical outcome. A large prospective study with long-term follow-up is now required to extend these findings and establish the optimal hematopoietic stem cell transplant conditioning for patients with at least some subgroups of non-malignant diseases.

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We thank all the physicians and data managers at the transplant centers who contributed data to the Japan Society for Hematopoietic Cell Transplantation, the Japan Marrow Donor Program, the Japan Cord Blood Bank Network, and the Japanese Society of Pediatric Hematology/Oncology.

Inherited Disease Working Group of the Japan Society for Hematopoietic Cell Transplantation

Katsutsugu Umeda, Hiromasa Yabe, Koji Kato, Kohsuke Imai, Nao Yoshida, Yoji Sasahara, Souichi Adachi, Tomohiro Morio.

Author information


  1. Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    • Katsutsugu Umeda
  2. Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, Isehara, Japan

    • Hiromasa Yabe
  3. Department of Hematology and Oncology, Children’s Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    • Koji Kato
    •  & Nao Yoshida
  4. Department of Community Pediatrics, Perinatal and Maternal Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    • Kohsuke Imai
    •  & Tomohiro Morio
  5. Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan

    • Masao Kobayashi
  6. Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan

    • Yoshiyuki Takahashi
  7. Department of Hematology/Oncology, Osaka Women’s and Children’s Hospital, Izumi, Japan

    • Maho Sato
    •  & Masami Inoue
  8. Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan

    • Yoji Sasahara
  9. Division of Pediatric Hematology and Oncology, Ibaraki Children’s Hospital, Mito, Japan

    • Keisuke Kato
  10. Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    • Souichi Adachi
  11. Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    • Yuhki Koga
  12. Department of Pediatric Hematology/Oncology, Osaka City General Hospital, Osaka, Japan

    • Keiko Okada
  13. Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan

    • Yoshiko Hashii
  14. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    • Yoshiko Atsuta


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  1. on behalf of the Inherited Disease Working Group of the Japan Society for Hematopoietic Cell Transplantation

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    Correspondence to Katsutsugu Umeda.

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