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Busulfan plus cyclophosphamide vs. total body irradiation plus cyclophosphamide for allogeneic hematopoietic stem cell transplantation in patients with acute T lymphoblastic leukemia: a large-scale propensity score matching-based study

Bone Marrow Transplantation (2024)Cite this article

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T-cell acute lymphoblastic leukemia (T-ALL) is a hematological malignancy with 5-year overall survival (OS) of less than 60% in adults and 85% in children due to improved intensive therapies [1,2,3]. Over the past few decades, allogeneic hematopoietic stem-cell transplantation (allo-HSCT) has been proved to improve the prognosis and even be a potential cure for T-ALL [1].

The two most common myeloablative conditioning regimens were total body irradiation (TBI) plus cyclophosphamide (TBI-Cy) and busulfan (Bu) plus cyclophosphamide (BuCy) [4]. TBI-Cy is mostly used in ALL patients as TBI possesses potent and distinct anti-leukemic effects in organs not easily affected by systemic chemotherapy [5]. However, TBI-based conditioning regimens may lead to cataracts, engraftment failure and even subsequent malignant neoplasms (SMNs) [6]. To avoid these disadvantages, intravenous Bu replaced TBI as a part of conditioning.

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Fig. 1: Survival outcomes of T-cell acute lymphoblastic leukemia (T-ALL) patients who underwent transplantation according to conditioning regimens.

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All databases and related metadata underlying this article will be shared by the corresponding authors if having reasonable request.

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Acknowledgements

This work was supported in part by grants from the National Key Research and Development Program (2022YFC2502700), the National Natural Science Foundation of China (82070187, 82370213), the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD), the Jiangsu Provincial Medical Innovation Center (CXZX202201), and the Suzhou Science and Technology Program Project (SLT201911).

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  1. These authors contributed equally: Yifan Shen, Minyuan Liu, Danya Shen, Mengqian Chu.

Authors and Affiliations

  1. Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, PR China

    Yifan Shen, Danya Shen, Mengqian Chu, Xuekai Li, Xiang Zhang, Yi Fan, Jia Chen, Depei Wu & Yang Xu

  2. Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, PR China

    Yifan Shen, Danya Shen, Mengqian Chu, Xuekai Li, Xiang Zhang, Yi Fan, Jia Chen, Depei Wu & Yang Xu

  3. Department of Hematology, Jiangsu Children Hematology and Oncology Center Children’s Hospital of Soochow University, Suzhou, PR China

    Minyuan Liu & Shaoyan Hu

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  1. Yifan Shen
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Contributions

Yang Xu, Shaoyan Hu and Depei Wu conceived the central idea of this study, designed this study, and revised this paper. Yifan Shen, Minyuan Liu, Danya Shen and Mengqian Chu collected the data, analyzed most of the databases, and wrote the initial manuscript of this paper. Xuekai Li, Xiang Zhang, Yi Fan and Jia Chen were responsible for assisting in other data analysis, and finalizing the paper.

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Correspondence to Depei Wu, Shaoyan Hu or Yang Xu.

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Shen, Y., Liu, M., Shen, D. et al. Busulfan plus cyclophosphamide vs. total body irradiation plus cyclophosphamide for allogeneic hematopoietic stem cell transplantation in patients with acute T lymphoblastic leukemia: a large-scale propensity score matching-based study. Bone Marrow Transplant (2024). https://doi.org/10.1038/s41409-024-02280-9

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