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Publications

Journal Article Ahead of print 1 citation

PubMed: 42624967 DOI: 10.1038/s41409-026-03014-9

Long-term complications after total body irradiation in children younger than 4 years transplanted for acute lymphoblastic leukemia.

Bone Marrow Transplant

Authors: Quentin Neven, Julie Berbis, Gérard Michel, Carine Domenech, Cécile Pochon, Sandrine Visentin, Cécile Renard, André Baruchel, Mony Fahd, Virginie Gandemer, Marilyne Poirée, Charlotte Jubert, Stéphane Ducassou, Catherine Paillard, Laura Olivier-Gougenheim, Alexandre Theron, Corinne Armari-Alla, Justyna Kanold, Sandrine Thouvenin-Doulet, Mathilde Veneziano Broccia, Caroline Thomas, Marie-Dominique Tabone, Guy Leverger, Pascal Auquier, Jean-Hugues Dalle, Paul Saultier

Affiliations

  • Hematology and immunology department, Robert Debré hospital, GHU APHP Nord, Université Paris Cité, Paris, France.
  • Department of Public Health, Aix Marseille Univ, APHM, CERESS, Marseille, France.
  • Department of pediatric hematology, immunology and oncology, Aix Marseille Univ, APHM, CERESS, La Timone Children's Hospital, Marseille, France.
  • Department of Pediatric Hematology and Oncology, IHOP, Hospices Civils de Lyon, Lyon 1 University, Lyon, France.
  • Department of Pediatric Onco-Hematology, Hôpital d'Enfants de Brabois, Vandoeuvre Les Nancy, France.
  • Department of Pediatric Hematology, Immunology and Oncology, La Timone Children's Hospital, Marseille, France.
  • Department of Pediatric Hematology and Oncology, IHOP, Hospices Civils de Lyon, Lyon, France.
  • Department of Pediatric Hematology and Oncology, University Hospital of Rennes, Rennes, France.
  • Pediatric Hematology and Oncology Department, University Hospital L'Archet, Nice, France.
  • Department of Pediatric Hematology and Oncology, University Hospital of Bordeaux, Bordeaux, France.
  • Department of Pediatric Hematology-oncology, University Hospital, Strasbourg, France.
  • Department of Pediatric Hematology and Oncology, University Hospital of Toulouse, Toulouse, France.
  • Department of Pediatric Hematology and Oncology, University Hospital, Montpellier, France.
  • Department of Pediatric Hematology-Oncology, University Hospital of Grenoble, Grenoble, France.
  • Department of Pediatric Hematology and Oncology, CIC Inserm 501, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
  • Department of Pediatric Hematology-Oncology, University Hospital St Etienne, St Etienne, France.
  • Department of Pediatric Hematology, Immunology and Oncology, Aix Marseille Univ, APHM, INSERM, INRAE, C2VN, La Timone Children's Hospital, Marseille, France.
  • Department of Pediatric Hematology and Oncology, CHU de Nantes, Nantes, France.
  • Department of Pediatric Hematology, Immunology and Oncology, Armand Trousseau Hospital, Sorbonne University, APHP, Paris, France.
  • Sorbonne University, INSERM, CRSA, UMR_S938, APHP, Groupe Hospitalier Sorbonne Université, Armand Trousseau Hospital, Paris, France.
  • Department of Pediatric Hematology, Immunology and Oncology, Aix Marseille Univ, APHM, INSERM, INRAE, C2VN, La Timone Children's Hospital, Marseille, France.

Abstract

Total body irradiation (TBI)-based conditioning is the standard regimen for allogeneic hematopoietic stem cell transplantation (HSCT) in high-risk or relapsed pediatric acute lymphoblastic leukemia (ALL), but is variably used before age 4 because of concerns about long-term toxicity. Long-term physical, educational, and quality-of-life outcomes were assessed in patients from the French long-term follow-up program LEA who underwent TBI-based HSCT for ALL at 2 to <4 years of age (younger group, n = 37) and compared with those of matched prepubertal older children transplanted at ≥4 years (older group, n = 105). After a mean follow-up of 15.6 years, the number of complications was similar in the two groups (3.3 vs 3.2, p = 0.90). Among the 20 complications analyzed, pulmonary dysfunction was the only event that differed significantly, being more frequent in the older group (43% vs 19%, p = 0.01). In a multivariate multistate model, age group was not associated with a higher risk of transition to a greater complication burden (HR 1.05, 95% CI 0.83-1.32; p = 0.70). Educational outcomes and quality of life were also comparable. These findings do not suggest greater long-term toxicity in children undergoing TBI-based HSCT at 2 to <4 years of age and support reconsideration of the lower age limit for its use.

MeSH

Precursor Cell Lymphoblastic Leukemia-Lymphoma, Whole-Body Irradiation, Leukemia, Child