{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:18:20Z","timestamp":1784546300471,"version":"3.55.0"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T00:00:00Z","timestamp":1772236800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T00:00:00Z","timestamp":1772236800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Allogeneic hematopoietic stem cell transplantation (allo\u2010HSCT) effectively treats high\u2010risk acute lymphoblastic leukemia (ALL), yet challenges persist due to post\u2010transplant relapse and conditioning regimen toxicities. The determination of an appropriate preconditioning regimen is critical to improving patient outcomes. In our transplant center, we have modified the traditional busulfan (Bu)\/cyclophosphamide (Cy)\/etoposide (Vp16) protocol by adding fludarabine (Flu) and cytarabine (Ara\u2010C), while reducing the dosage of Cy. This novel modification seeks to enhance transplantation outcomes for ALL patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study retrospectively collected clinical data from 88 high\u2010risk ALL patients who received transplantation from June 2018 to December 2023. Among these patients, 40 received the novel modified Bu\/Cy\/Vp16\/Flu\/Ara\u2010C conditioning protocol, while 48 received the traditional Bu\/Cy\/Vp16 regimen and served as a control group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      This study demonstrated a notably reduced incidence of cardiac toxicity in patients treated with the modified Bu\/Cy\/Vp16\/Flu\/Ara\u2010C conditioning compared to those on the traditional Bu\/Cy\/Vp16 regimen. Furthermore, other types of conditioning\u2010related toxicities were within acceptable limits in the modified regimen group. Regarding efficacy, the Bu\/Cy\/Vp16\/Flu\/Ara\u2010C protocol significantly reduced the cumulative two\u2010year relapse rate in high\u2010risk ALL patients compared to the Bu\/Cy\/Vp16 scheme (38.7% (20.9%\u201352.5%) vs. 11.8% (0.2%\u201322.1%),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017). The modified regimen showed significant improvements in 2\u2010year overall survival at 71.6% (57.1%\u201389.6%) compared to 50.6% (38%\u201367.3%) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.048), and in two\u2010year disease\u2010free survival at 66.7% (51.9%\u201385.6%) compared to 45.3% (33.1%\u201362.1%) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015). Transplant\u2010related mortality was comparable between the two groups. A subgroup analysis based on disease status (CR1 and \u2265\u2009CR2) revealed that high\u2010risk ALL patients on the modified regimen had lower relapse rates and significantly better OS and DFS than those on the Bu\/Cy\/Vp16 scheme.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The novel modified Bu\/Cy\/Vp16\/Flu\/Ara\u2010C conditioning significantly enhances the prognosis of high\u2010risk ALL patients receiving transplantation, especially those in CR1.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71669","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T11:11:35Z","timestamp":1772968295000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Novel Modified Bu\/Vp16\/cy\/Flu\/Ara\u2010C Conditioning Regimen Enhances Outcomes for High\u2010Risk Acute Lymphoblastic Leukemia Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation"],"prefix":"10.1002","volume":"15","author":[{"given":"Xiaoyan","family":"Zhao","sequence":"first","affiliation":[{"name":"Institute of Pediatrics, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"Yao","sequence":"additional","affiliation":[{"name":"Institute of Hematology, Union Hospital, Tongji Medical College Huazhong University of Science and Technology  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Sun","sequence":"additional","affiliation":[{"name":"Institute of Thoracic Surgery, Union Hospital, Tongji Medical College Huazhong University of Science and Technology  Wuhan 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