{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T01:09:22Z","timestamp":1792372162019,"version":"4.4.0"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T00:00:00Z","timestamp":1714694400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T00:00:00Z","timestamp":1714694400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Bone Marrow Transplant"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Allogeneic hematopoietic stem cell transplantation (allo-HCT) is a standard treatment for patients with AML and MDS. The combination of fractionated total body irradiation(8GyTBI\/Flu) with fludarabine is an established conditioning regimen, but fludarabine\/treosulfan(Flu\/Treo) constitutes an alternative in older\/comorbid patients. We conducted a retrospective analysis of 215 AML(in CR) and 96 MDS patients undergoing their first allo-HCT between 2011 and 2022, identifying 53 matched Flu\/Treo and 8GyTBI\/Flu patients through propensity score matching. Median follow-up of survivors was 3.3 years and 4.1 years. For the Flu\/Treo group, 1-year non-relapse mortality (2% vs. 10%, <jats:italic>p<\/jats:italic>\u2009=\u20090.03) was lower, while 1-year relapse incidence (16% vs. 13%, <jats:italic>p<\/jats:italic>\u2009=\u20090.81) was similar. Three-year outcomes, including relapse-free survival and graft-versus-host disease incidence, were comparable (OS: 81% vs. 74%, <jats:italic>p<\/jats:italic>\u2009=\u20090.70; RFS: 78% vs. 66%, <jats:italic>p<\/jats:italic>\u2009=\u20090.28; chronic GvHD: 34% vs. 36%, <jats:italic>p<\/jats:italic>\u2009=\u20090.97; acute GvHD (100 days): 11% vs. 23%, <jats:italic>p<\/jats:italic>\u2009=\u20090.11). Multivariable analysis, considering age, ECOG, HCT-CI, and MRD status, revealed no associations with main outcomes. Dose-reduced conditioning with Flu\/Treo or 8GyTBI\/Flu demonstrated favorable and comparable survival rates exceeding 70% at 3 years with 1-year NRM rates below 10% and low relapse rates in the matched cohort. These data underline the need for further evaluation of TBI and Treo-based conditionings in prospective trials.<\/jats:p>","DOI":"10.1038\/s41409-024-02295-2","type":"journal-article","created":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T14:02:23Z","timestamp":1714744943000},"page":"1097-1106","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Comparable outcomes for TBI-based versus treosulfan based conditioning prior to allogeneic hematopoietic stem cell transplantation in AML and MDS patients"],"prefix":"10.1038","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4152-0366","authenticated-orcid":false,"given":"Philipp","family":"Berning","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Kolloch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Reicherts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Call","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Marx","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Floeth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Esseling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Ronnacker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5534-7250","authenticated-orcid":false,"given":"J\u00f6rn","family":"Albring","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1755-9583","authenticated-orcid":false,"given":"Christoph","family":"Schliemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4728-1693","authenticated-orcid":false,"given":"Georg","family":"Lenz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9331-5145","authenticated-orcid":false,"given":"Matthias","family":"Stelljes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,5,3]]},"reference":[{"key":"2295_CR1","doi-asserted-by":"publisher","first-page":"1156","DOI":"10.1182\/blood-2017-03-772368","volume":"130","author":"L Muffly","year":"2017","unstructured":"Muffly L, Pasquini MC, Martens M, Brazauskas R, Zhu X, Adekola K, et al. Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States. Blood. 2017;130:1156\u201364. https:\/\/doi.org\/10.1182\/blood-2017-03-772368.","journal-title":"Blood"},{"key":"2295_CR2","doi-asserted-by":"publisher","first-page":"2230","DOI":"10.1200\/JCO.2010.33.7212","volume":"29","author":"JR Wingard","year":"2011","unstructured":"Wingard JR, Majhail NS, Brazauskas R, Wang Z, Sobocinski KA, Jacobsohn D, et al. Long-term survival and late deaths after allogeneic hematopoietic cell transplantation. J Clin Oncol. 2011;29:2230\u20139. https:\/\/doi.org\/10.1200\/JCO.2010.33.7212.","journal-title":"J Clin Oncol"},{"key":"2295_CR3","doi-asserted-by":"publisher","first-page":"2744","DOI":"10.1182\/blood-2007-03-078592","volume":"110","author":"C Kahl","year":"2007","unstructured":"Kahl C, Storer BE, Sandmaier BM, Mielcarek M, Maris MB, Blume KG, et al. Relapse risk in patients with malignant diseases given allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning. Blood. 2007;110:2744\u20138. https:\/\/doi.org\/10.1182\/blood-2007-03-078592.","journal-title":"Blood"},{"key":"2295_CR4","doi-asserted-by":"publisher","first-page":"4570","DOI":"10.1200\/JCO.2008.20.9692","volume":"27","author":"O Ringden","year":"2009","unstructured":"Ringden O, Labopin M, Ehninger G, Niederwieser D, Olsson R, Basara N, et al. Reduced intensity conditioning compared with myeloablative conditioning using unrelated donor transplants in patients with acute myeloid leukemia. J Clin Oncol. 2009;27:4570\u20137. https:\/\/doi.org\/10.1200\/JCO.2008.20.9692.","journal-title":"J Clin Oncol"},{"key":"2295_CR5","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.1200\/JCO.2016.70.7091","volume":"35","author":"BL Scott","year":"2017","unstructured":"Scott BL, Pasquini MC, Logan BR, Wu J, Devine SM, Porter DL, et al. Myeloablative Versus Reduced-Intensity Hematopoietic Cell Transplantation for Acute Myeloid Leukemia and Myelodysplastic Syndromes. J Clin Oncol. 2017;35:1154\u201361. https:\/\/doi.org\/10.1200\/JCO.2016.70.7091.","journal-title":"J Clin Oncol"},{"key":"2295_CR6","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1200\/JCO.19.03011","volume":"38","author":"CS Hourigan","year":"2020","unstructured":"Hourigan CS, Dillon LW, Gui G, Logan BR, Fei M, Ghannam J, et al. Impact of Conditioning Intensity of Allogeneic Transplantation for Acute Myeloid Leukemia With Genomic Evidence of Residual Disease. J Clin Oncol. 2020;38:1273\u201383. https:\/\/doi.org\/10.1200\/JCO.19.03011.","journal-title":"J Clin Oncol"},{"key":"2295_CR7","doi-asserted-by":"publisher","first-page":"3314","DOI":"10.1182\/blood-2005-04-1377","volume":"106","author":"M Stelljes","year":"2005","unstructured":"Stelljes M, Bornhauser M, Kroger M, Beyer J, Sauerland MC, Heinecke A, et al. Conditioning with 8-Gy total body irradiation and fludarabine for allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia. Blood. 2005;106:3314\u201321. https:\/\/doi.org\/10.1182\/blood-2005-04-1377.","journal-title":"Blood"},{"key":"2295_CR8","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.1016\/S1470-2045(12)70349-2","volume":"13","author":"M Bornhauser","year":"2012","unstructured":"Bornhauser M, Kienast J, Trenschel R, Burchert A, Hegenbart U, Stadler M, et al. Reduced-intensity conditioning versus standard conditioning before allogeneic haemopoietic cell transplantation in patients with acute myeloid leukaemia in first complete remission: a prospective, open-label randomised phase 3 trial. Lancet Oncol. 2012;13:1035\u201344. https:\/\/doi.org\/10.1016\/S1470-2045(12)70349-2.","journal-title":"Lancet Oncol"},{"key":"2295_CR9","doi-asserted-by":"publisher","first-page":"e28","DOI":"10.1016\/S2352-3026(19)30157-7","volume":"7","author":"DW Beelen","year":"2020","unstructured":"Beelen DW, Trenschel R, Stelljes M, Groth C, Masszi T, Remenyi P, et al. Treosulfan or busulfan plus fludarabine as conditioning treatment before allogeneic haemopoietic stem cell transplantation for older patients with acute myeloid leukaemia or myelodysplastic syndrome (MC-FludT.14\/L): a randomised, non-inferiority, phase 3 trial. Lancet Haematol. 2020;7:e28\u201339. https:\/\/doi.org\/10.1016\/S2352-3026(19)30157-7.","journal-title":"Lancet Haematol"},{"key":"2295_CR10","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1016\/j.bbmt.2010.02.021","volume":"16","author":"SH Armenian","year":"2010","unstructured":"Armenian SH, Sun CL, Mills G, Teh JB, Francisco L, Durand JB, et al. Predictors of late cardiovascular complications in survivors of hematopoietic cell transplantation. Biol Blood Marrow Transpl. 2010;16:1138\u201344. https:\/\/doi.org\/10.1016\/j.bbmt.2010.02.021.","journal-title":"Biol Blood Marrow Transpl"},{"key":"2295_CR11","doi-asserted-by":"publisher","first-page":"1765","DOI":"10.1182\/blood-2006-05-022335","volume":"109","author":"KS Baker","year":"2007","unstructured":"Baker KS, Ness KK, Steinberger J, Carter A, Francisco L, Burns LJ, et al. Diabetes, hypertension, and cardiovascular events in survivors of hematopoietic cell transplantation: a report from the bone marrow transplantation survivor study. Blood. 2007;109:1765\u201372. https:\/\/doi.org\/10.1182\/blood-2006-05-022335.","journal-title":"Blood"},{"key":"2295_CR12","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1038\/s41409-023-01965-x","volume":"58","author":"G Bug","year":"2023","unstructured":"Bug G, Labopin M, Niittyvuopio R, Stelljes M, Reinhardt HC, Hilgendorf I, et al. Fludarabine\/TBI 8 Gy versus fludarabine\/treosulfan conditioning in patients with AML in first complete remission: a study from the Acute Leukemia Working Party of the EBMT. Bone Marrow Transpl. 2023;58:710\u20136. https:\/\/doi.org\/10.1038\/s41409-023-01965-x.","journal-title":"Bone Marrow Transpl"},{"key":"2295_CR13","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1038\/nrclinonc.2012.150","volume":"9","author":"JJ Cornelissen","year":"2012","unstructured":"Cornelissen JJ, Gratwohl A, Schlenk RF, Sierra J, Bornhauser M, Juliusson G, et al. The European LeukemiaNet AML Working Party consensus statement on allogeneic HSCT for patients with AML in remission: an integrated-risk adapted approach. Nat Rev Clin Oncol. 2012;9:579\u201390. https:\/\/doi.org\/10.1038\/nrclinonc.2012.150.","journal-title":"Nat Rev Clin Oncol"},{"key":"2295_CR14","doi-asserted-by":"publisher","first-page":"4570","DOI":"10.1182\/bloodadvances.2022007168","volume":"6","author":"M Jentzsch","year":"2022","unstructured":"Jentzsch M, Bischof L, Backhaus D, Brauer D, Schulz J, Franke GN, et al. Impact of MRD status in patients with AML undergoing allogeneic stem cell transplantation in the first vs the second remission. Blood Adv. 2022;6:4570\u201380. https:\/\/doi.org\/10.1182\/bloodadvances.2022007168","journal-title":"Blood Adv"},{"key":"2295_CR15","doi-asserted-by":"publisher","first-page":"3318","DOI":"10.1200\/JCO.20.02724","volume":"39","author":"N Kroger","year":"2021","unstructured":"Kroger N, Sockel K, Wolschke C, Bethge W, Schlenk RF, Wolf D, et al. Comparison Between 5-Azacytidine Treatment and Allogeneic Stem-Cell Transplantation in Elderly Patients With Advanced MDS According to Donor Availability (VidazaAllo Study). J Clin Oncol. 2021;39:3318\u201327. https:\/\/doi.org\/10.1200\/JCO.20.02724.","journal-title":"J Clin Oncol"},{"key":"2295_CR16","doi-asserted-by":"publisher","first-page":"3863","DOI":"10.1182\/blood-2013-07-514448","volume":"122","author":"EA Copelan","year":"2013","unstructured":"Copelan EA, Hamilton BK, Avalos B, Ahn KW, Bolwell BJ, Zhu X, et al. Better leukemia-free and overall survival in AML in first remission following cyclophosphamide in combination with busulfan compared with TBI. Blood. 2013;122:3863\u201370. https:\/\/doi.org\/10.1182\/blood-2013-07-514448.","journal-title":"Blood"},{"key":"2295_CR17","doi-asserted-by":"publisher","first-page":"3549","DOI":"10.1200\/JCO.2013.48.8114","volume":"31","author":"A Nagler","year":"2013","unstructured":"Nagler A, Rocha V, Labopin M, Unal A, Ben Othman T, Campos A, et al. Allogeneic hematopoietic stem-cell transplantation for acute myeloid leukemia in remission: comparison of intravenous busulfan plus cyclophosphamide (Cy) versus total-body irradiation plus Cy as conditioning regimen\u2013a report from the acute leukemia working party of the European group for blood and marrow transplantation. J Clin Oncol. 2013;31:3549\u201356. https:\/\/doi.org\/10.1200\/JCO.2013.48.8114.","journal-title":"J Clin Oncol"},{"key":"2295_CR18","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.1038\/s41409-020-0803-y","volume":"55","author":"A Spyridonidis","year":"2020","unstructured":"Spyridonidis A, Labopin M, Savani BN, Niittyvuopio R, Blaise D, Craddock C, et al. Redefining and measuring transplant conditioning intensity in current era: a study in acute myeloid leukemia patients. Bone Marrow Transpl. 2020;55:1114\u201325. https:\/\/doi.org\/10.1038\/s41409-020-0803-y.","journal-title":"Bone Marrow Transpl"},{"key":"2295_CR19","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1038\/s41409-020-01050-7","volume":"56","author":"S Giebel","year":"2021","unstructured":"Giebel S, Labopin M, Sobczyk-Kruszelnicka M, Stelljes M, Byrne JL, Fegueux N, et al. Total body irradiation + fludarabine compared to busulfan + fludarabine as \u201creduced-toxicity conditioning\u201d for patients with acute myeloid leukemia treated with allogeneic hematopoietic cell transplantation in first complete remission: a study by the Acute Leukemia Working Party of the EBMT. Bone Marrow Transpl. 2021;56:481\u201391. https:\/\/doi.org\/10.1038\/s41409-020-01050-7.","journal-title":"Bone Marrow Transpl"},{"key":"2295_CR20","doi-asserted-by":"publisher","unstructured":"Oertel M, Kittel C, Martel J, Mikesch JH, Glashoerster M, Stelljes M, et al. Pulmonary Toxicity after Total Body Irradiation-An Underrated Complication? Estimation of Risk via Normal Tissue Complication Probability Calculations and Correlation with Clinical Data. Cancers (Basel) 2021; 13. https:\/\/doi.org\/10.3390\/cancers13122946.","DOI":"10.3390\/cancers13122946"},{"key":"2295_CR21","doi-asserted-by":"publisher","first-page":"2671","DOI":"10.1002\/cncr.30646","volume":"123","author":"A Nagler","year":"2017","unstructured":"Nagler A, Labopin M, Beelen D, Ciceri F, Volin L, Shimoni A, et al. Long-term outcome after a treosulfan-based conditioning regimen for patients with acute myeloid leukemia: A report from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Cancer. 2017;123:2671\u20139. https:\/\/doi.org\/10.1002\/cncr.30646.","journal-title":"Cancer"},{"key":"2295_CR22","doi-asserted-by":"publisher","first-page":"e161","DOI":"10.1016\/S2352-3026(18)30022-X","volume":"5","author":"F Fasslrinner","year":"2018","unstructured":"Fasslrinner F, Schetelig J, Burchert A, Kramer M, Trenschel R, Hegenbart U, et al. Long-term efficacy of reduced-intensity versus myeloablative conditioning before allogeneic haemopoietic cell transplantation in patients with acute myeloid leukaemia in first complete remission: retrospective follow-up of an open-label, randomised phase 3 trial. Lancet Haematol. 2018;5:e161\u20139. https:\/\/doi.org\/10.1016\/S2352-3026(18)30022-X.","journal-title":"Lancet Haematol"},{"key":"2295_CR23","doi-asserted-by":"publisher","DOI":"10.1038\/s41408-021-00479-3","volume":"11","author":"MH Gilleece","year":"2021","unstructured":"Gilleece MH, Shimoni A, Labopin M, Robinson S, Beelen D, Socie G, et al. Measurable residual disease status and outcome of transplant in acute myeloid leukemia in second complete remission: a study by the acute leukemia working party of the EBMT. Blood Cancer J. 2021;11:88. https:\/\/doi.org\/10.1038\/s41408-021-00479-3.","journal-title":"Blood Cancer J"}],"container-title":["Bone Marrow Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41409-024-02295-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41409-024-02295-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41409-024-02295-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T09:15:29Z","timestamp":1722590129000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41409-024-02295-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,3]]},"references-count":23,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,8]]}},"alternative-id":["2295"],"URL":"https:\/\/doi.org\/10.1038\/s41409-024-02295-2","relation":{},"ISSN":["0268-3369","1476-5365"],"issn-type":[{"value":"0268-3369","type":"print"},{"value":"1476-5365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,3]]},"assertion":[{"value":"4 February 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 April 2024","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 April 2024","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 May 2024","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"CS received research grants not related to this manuscript from Jazz, Boehringer Ingelheim, AngioBiomed. CS received honoraria from AbbVie, Astellas, AstraZeneca, BMS, Laboratories Delbert, Jazz, Novartis, Pfizer; and travel support from AbbVie, BMS, Jazz and Pfizer. GL received research grants not related to this manuscript from AGIOS, AQUINOX, AstraZeneca, Bayer, Celgene, Gilead, Janssen, Morphosys, Novartis, Roche, and Verastem. GL received honoraria from ADC Therapeutics, Abbvie, Amgen, AstraZeneca, Bayer, BMS, Celgene, Constellation, Genase, Genmab, Gilead, Hexal-Sandoz, Immagene, Incyte, Janssen, Karyopharm, Lilly, Miltenyi, Morphosys, NanoString, Novartis, PentixaPharm, Roche, Sobi and Takeda. MS received honoraria from medac GmbH, has been paid to participate in a speakers\u2019 bureau by medac GmbH and received travel and accommodation expenses from medac GmbH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the local Ethics Committee.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"IRB approval"}}]}}