{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:42:09Z","timestamp":1787240529401,"version":"build-2736575974"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Germany"},{"name":"Renate Arnold"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Bone Marrow Transplant"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Total body irradiation (TBI) plus chemotherapy is commonly applied prior to allogeneic hematopoietic stem cell transplantation (SCT) for patients with acute lymphoblastic leukemia (ALL). Here, we retrospectively analyzed registry data from the German Multicenter Study Group for Adult ALL (GMALL) and report the outcomes for 111 adult ALL patients who received 8\u2009Gy TBI-based SCT conditioning in first complete remission between 2002 and 2018 after initial treatment with pediatric-based approaches. Patients had a median age of 52 years (range 18\u201365) at initial diagnosis, and the majority of patients (93%) had a good performance status (ECOG 0\/1). 97 patients (87%) showed high-risk features according to GMALL criteria, of whom 58 (60%) were Philadelphia chromosome\/\n                    <jats:italic>BCR::ABL1<\/jats:italic>\n                    -positive. With a median follow-up of 3.1 years after SCT, the survival rates at one, three, and five years were 72%, 64%, and 57% for disease-free survival, and 76%, 67%, and 61% for overall survival, respectively. The rates of non-relapse mortality at one, three, and five years were 22%, 26%, and 30%, while the cumulative incidences of relapse were 7%, 10%, and 14%, respectively. In summary, 8\u2009Gy TBI conditioning in ALL patients was feasible and resulted in outcomes similar to those previously reported for 12\u2009Gy conditioning regimens.\n                  <\/jats:p>","DOI":"10.1038\/s41409-025-02762-4","type":"journal-article","created":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T10:24:25Z","timestamp":1765016665000},"page":"303-311","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Reduced intensity conditioning with 8\u2009Gy total body irradiation in adult patients with acute lymphoblastic leukemia"],"prefix":"10.1038","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1899-3261","authenticated-orcid":false,"given":"Klaus","family":"Wethmar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Edinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"Sch\u00e4fer-Eckart","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"}]},{"given":"Thomas","family":"Schroeder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Sohlbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renate","family":"Arnold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Stadler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2359-131X","authenticated-orcid":false,"given":"Gesine","family":"Bug","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Bornh\u00e4user","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Wulf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6052-2618","authenticated-orcid":false,"given":"Wolfgang","family":"Bethge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar","family":"Jost","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Teschner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9745-8813","authenticated-orcid":false,"given":"Guido","family":"Kobbe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5514-5010","authenticated-orcid":false,"given":"Monika","family":"Br\u00fcggemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Reiser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieter","family":"Hoelzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"G\u00f6kbuget","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4853-5579","authenticated-orcid":false,"given":"Stefan","family":"Sch\u00f6nland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,6]]},"reference":[{"key":"2762_CR1","doi-asserted-by":"publisher","first-page":"1560","DOI":"10.1038\/s41409-020-0878-5","volume":"55","author":"Z Peric","year":"2020","unstructured":"Peric Z, Labopin M, Peczynski C, Polge E, Cornelissen J, Carpenter B, et al. Comparison of reduced-intensity conditioning regimens in patients with acute lymphoblastic leukemia >45 years undergoing allogeneic stem cell transplantation\u2014a retrospective study by the Acute Leukemia Working Party of EBMT. Bone Marrow Transpl. 2020;55:1560\u20139.","journal-title":"Bone Marrow Transpl"},{"key":"2762_CR2","first-page":"834","volume":"28","author":"DW Beelen","year":"2022","unstructured":"Beelen DW, Arnold R, Stelljes M, Alakel N, Brecht A, Bug G, et al. Long-term results of allogeneic stem cell transplantation in adult Ph- negative high-risk acute lymphoblastic leukemia. Transpl Cell Ther. 2022;28:834\u201342.","journal-title":"Transpl Cell Ther"},{"key":"2762_CR3","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1038\/s41409-023-01966-w","volume":"58","author":"K Hirschb\u00fchl","year":"2023","unstructured":"Hirschb\u00fchl K, Labopin M, Polge E, Blaise D, Bourhis JH, Soci\u00e9 G, et al. Total body irradiation versus busulfan based intermediate intensity conditioning for stem cell transplantation in ALL patients >45 years-a registry-based study by the Acute Leukemia Working Party of the EBMT. Bone Marrow Transpl. 2023;58:874\u201380.","journal-title":"Bone Marrow Transpl"},{"key":"2762_CR4","doi-asserted-by":"publisher","first-page":"e812","DOI":"10.1097\/HS9.0000000000000812","volume":"7","author":"A Spyridonidis","year":"2023","unstructured":"Spyridonidis A, Labopin M, Savani B, Giebel S, Bug G, Sch\u00f6nland S, et al. Reduced 8-gray compared to standard 12-gray total body irradiation for allogeneic transplantation in first remission acute lymphoblastic leukemia: a study of the Acute Leukemia Working Party of the EBMT. Hemasphere. 2023;7:e812.","journal-title":"Hemasphere"},{"key":"2762_CR5","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1038\/s41409-025-02522-4","volume":"60","author":"I Kr\u00e4mer","year":"2025","unstructured":"Kr\u00e4mer I, K\u00f6nig L, Luft T, Hegenbart U, Sch\u00f6nland S, Eichkorn T, et al. Intermediate-dose TBI\/fludarabine conditioning for allogeneic hematopoietic cell transplantation in patients with peripheral T-cell lymphoma. Bone Marrow Transpl. 2025;60:581\u20136.","journal-title":"Bone Marrow Transpl"},{"key":"2762_CR6","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1038\/s41409-022-01841-0","volume":"58","author":"A Banet","year":"2023","unstructured":"Banet A, Bazarbachi A, Labopin M, Stocker N, Dul\u00e9ry R, Malard F, et al. Thiotepa, busulfan and fludarabine conditioning-regimen is a promising approach for older adult patients with acute lymphoblastic leukemia treated with allogeneic stem cell transplantation. Bone Marrow Transpl. 2023;58:61\u201367.","journal-title":"Bone Marrow Transpl"},{"key":"2762_CR7","first-page":"95","volume":"30","author":"G Battipaglia","year":"2024","unstructured":"Battipaglia G, Labopin M, Mielke S, Ruggeri A, Nur Ozkurt Z, Bourhis JH, et al. Thiotepa-based regimens are valid alternatives to total body irradiation-based reduced-intensity conditioning regimens in patients with acute lymphoblastic leukemia: a retrospective study on Behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Transpl Cell Ther. 2024;30:95.","journal-title":"Transpl Cell Ther"},{"key":"2762_CR8","doi-asserted-by":"publisher","first-page":"2561","DOI":"10.1097\/TP.0000000000004706","volume":"107","author":"A Sijs-Szabo","year":"2023","unstructured":"Sijs-Szabo A, Dinmohamed AG, Versluis J, Van Der Holt B, Bellido M, Hazenberg MD, et al. Allogeneic stem cell transplantation in patients >40 years of age with acute lymphoblastic leukemia: reduced intensity versus myeloablative conditioning. Transplantation. 2023;107:2561\u20137.","journal-title":"Transplantation"},{"key":"2762_CR9","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1186\/s13045-019-0790-x","volume":"12","author":"J Pavl\u016f","year":"2019","unstructured":"Pavl\u016f J, Labopin M, Niittyvuopio R, Soci\u00e9 G, Yakoub-Agha I, Wu D, et al. Measurable residual disease at myeloablative allogeneic transplantation in adults with acute lymphoblastic leukemia: a retrospective registry study on 2780 patients from the acute leukemia working party of the EBMT. J Hematol Oncol. 2019;12:108.","journal-title":"J Hematol Oncol"},{"key":"2762_CR10","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1200\/JCO.20.02529","volume":"39","author":"C Peters","year":"2021","unstructured":"Peters C, Dalle JH, Locatelli F, Poetschger U, Sedlacek P, Buechner J, et al. Total body irradiation or chemotherapy conditioning in childhood all: a multinational, randomized, noninferiority phase III study. J Clin Oncol. 2021;39:295\u2013307.","journal-title":"J Clin Oncol"},{"key":"2762_CR11","doi-asserted-by":"publisher","first-page":"e22002","DOI":"10.1200\/JCO.2022.40.16_suppl.e22002","volume":"40","author":"MEU Rehman","year":"2022","unstructured":"Rehman MEU, Chattaraj A, Mahboob A, Ijaz Z, Franco D, Aslam MM, et al. Total body irradiation versus chemotherapy conditioning in pediatric acute lymphoblastic leukemia patients undergoing hematopoietic stem cell transplant: a systematic review and meta-analysis. J Clin Oncol. 2022;40:e22002.","journal-title":"J Clin Oncol"},{"key":"2762_CR12","first-page":"171.e1","volume":"27","author":"B Dholaria","year":"2021","unstructured":"Dholaria B, Labopin M, Angelucci E, Tischer J, Arat M, Ciceri F, et al. Improved outcomes of haploidentical hematopoietic cell transplantation with total body irradiation-based myeloablative conditioning in acute lymphoblastic leukemia. Transpl Cell Ther. 2021;27:171.e1\u2013171.e8.","journal-title":"Transpl Cell Ther"},{"key":"2762_CR13","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1200\/JCO.22.00767","volume":"41","author":"H Zhang","year":"2023","unstructured":"Zhang H, Fan Z, Huang F, Han L, Xu Y, Xu N, et al. Busulfan plus cyclophosphamide versus total body irradiation plus cyclophosphamide for adults acute B lymphoblastic leukemia: an open-label, multicenter, phase III trial. J Clin Oncol. 2023;41:343\u201353.","journal-title":"J Clin Oncol"},{"key":"2762_CR14","doi-asserted-by":"publisher","first-page":"1503","DOI":"10.1038\/bmt.2015.202","volume":"50","author":"N Kr\u00f6ger","year":"2015","unstructured":"Kr\u00f6ger N, Bornh\u00e4user M, Stelljes M, Pichlmeier U, Trenschel R, Schmid C, et al. Allogeneic stem cell transplantation after conditioning with treosulfan, etoposide and cyclophosphamide for patients with ALL: a phase II-study on behalf of the German Cooperative Transplant Study Group and ALL Study Group (GMALL). Bone Marrow Transpl. 2015;50:1503\u20137.","journal-title":"Bone Marrow Transpl"},{"key":"2762_CR15","first-page":"620.e1","volume":"27","author":"F Khimani","year":"2021","unstructured":"Khimani F, Dutta M, Faramand R, Nishihori T, Perez AP, Dean E, et al. Impact of total body irradiation-based myeloablative conditioning regimens in patients with acute lymphoblastic leukemia undergoing allogeneic hematopoietic stem cell transplantation: systematic review and meta-analysis. Transpl Cell Ther. 2021;27:620.e1\u2013620.e9.","journal-title":"Transpl Cell Ther"},{"key":"2762_CR16","doi-asserted-by":"publisher","first-page":"1146","DOI":"10.1016\/S0140-6736(19)33018-1","volume":"395","author":"F Malard","year":"2020","unstructured":"Malard F, Mohty M. Acute lymphoblastic leukaemia. Lancet. 2020;395:1146\u201362.","journal-title":"Lancet"},{"key":"2762_CR17","doi-asserted-by":"publisher","first-page":"1891","DOI":"10.1182\/blood.2023020794","volume":"143","author":"N G\u00f6kbuget","year":"2024","unstructured":"G\u00f6kbuget N, Boissel N, Chiaretti S, Dombret H, Doubek M, Fielding A, et al. Diagnosis, prognostic factors, and assessment of ALL in adults: 2024 ELN recommendations from a European expert panel. Blood. 2024;143:1891\u2013902.","journal-title":"Blood"},{"key":"2762_CR18","first-page":"611","volume":"29","author":"MB Abid","year":"2023","unstructured":"Abid MB, Estrada-Merly N, Zhang MJ, Chen K, Bredeson C, Allan D, et al. Younger matched unrelated donors confer decreased relapse risk compared to older sibling donors in older patients with B cell acute lymphoblastic leukemia undergoing allogeneic hematopoietic cell transplantation. Transpl Cell Ther. 2023;29:611\u20138.","journal-title":"Transpl Cell Ther"}],"container-title":["Bone Marrow Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41409-025-02762-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41409-025-02762-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41409-025-02762-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T14:56:07Z","timestamp":1772808967000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41409-025-02762-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,6]]},"references-count":18,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["2762"],"URL":"https:\/\/doi.org\/10.1038\/s41409-025-02762-4","relation":{},"ISSN":["0268-3369","1476-5365"],"issn-type":[{"value":"0268-3369","type":"print"},{"value":"1476-5365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,6]]},"assertion":[{"value":"1 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 November 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 November 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 December 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"KW received honoraria for invited presentations and advisory boards from Amgen, AstraZeneca, BMS, Merck, MSD, Pfizer, Pierre-Fabre, and Takeda. DT has received research grants from Gilead, honoraria from and served as a consultant for AbbVie, BioNTech, Daiichi Sankyo, Gilead, iQone, Jazz, Mikrogen, MSD, Noscendo, Octapharma, Pfizer, Tillotts, and Takeda, honoraria from AstraZeneca, F2G, Janssen, Novartis, and Sanofi, and travel grants from AbbVie, Astellas, Celgene, Gilead, Jazz, Medac, MSD, and Tillotts. MBo received honoraria for presentations and advisory boards from Jazz Pharmaceuticals, Actitrexx and MSD. MBr received honoraria for invited presentations and advisory boards from Amgen, Celgene, HelloHealthcare, Incyte, Janssen and Pfizer and institutional research support from Amgen and Autolus. NG received honoraria for invited presentations and advisory boards as well as institutional research support from Pfizer, Amgen, Novartis and Gilead Sciences. All other authors have declared that they have no potential conflicts of interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"All protocols were approved by local and national authorities and were in accordance with relevant guidelines and regulations. The study protocols were approved by the Ethics Committee of the Goethe University, Frankfurt, and the Medical Association of Hesse, Frankfurt, Germany (File numbers 30\/03 for NCT00198991, 171\/99 for NCT00199056, and 69\/09 for NCT02872987). Institutional Review Board\/Ethics Committee-approved written informed consent was obtained from each participant prior to enrollment.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}]}}