The aim of the study was to compare the therapeutic efficacy of total body irradiation (TBI)/
cyclophosphamide (CY) versus BU/CY as conditioning regimen for
leukemia. We electronically searched the Cochrane Central Register of Controlled Trials, Medline, Embase, CIBMTR and critically appraised all relevant articles (1990.01-2009.04). Comparative studies were evaluated on clinical
therapeutic effects of TBI/CY and
busulphan BU/CY regimens with assessement of engraftment, relapse, complications, and disease-free survival (DFS). Eighteen trials totaling 3172 patients have been assessed. Pooled comparisons of studies indicated that for patients with acute
leukemia (ALL and AML), the TBI/CY regimen lead to lower rates of
leukemia relapse, lower transplant-related mortality (TRM), and higher DFS, while for
chronic myeloid leukemia (CML), the TBI/CY regimen had a higher rate of
leukemia relapse, lower TRM, and similar DFS. The TBI/CY regimen was associated with similar occurrence of engraftment, acute and
chronic graft-versus-host disease (GVHD), but with higher rates of
cataract [odds ratio (OR) 12.69, p = 0.01],
interstitial pneumonitis, later growth or development problems [OR 5.04, p = 0.008]. BU/CY regimen was associated with higher rates of complications like liver veno-occlusive disease [OR 0.43, p < 0.00001],
hemorrhagic cystitis, and TRM. Our meta-analysis confirmed that different regimens and type of
leukemia may affect the complications and outcome. An analysis of the effects of other regimens need to be carried out by large sample and well-designed clinical trials.