Total Body IrradiationTotal Body Irradiation

Nancy J Tarbell, MD

ContentsContents

• BMT Background/History

• TBI technique, dose rate and fractionation

• Acute Effects

• Late Effects

• References

Diseases where TBI is usedDiseases where TBI is used

• Malignant– Leukemias

– Lymphomas

– Myelodysplasia

– Multiple Myeloma

– Pediatric solid tumors

– Adult solid tumors

• Nonmalignant– Aplastic Anemia

– Fanconi’s anemia

– Wiskott-Aldrich syndrome

– other genetic disorders

Reasons for BMT in LeukemiaReasons for BMT in Leukemia

• Poor prognosis chromosomal abnormalities

• Prior myelodysplasia

• Secondary AML

• Prolonged Induction

• Relapsing/Refractory Disease

Concept of ConditioningConcept of Conditioning

– Goals• create “space” in bone

marrow for graft

• immunosuppression

• tumor kill

– TBI/Cytoxan – Busulfan/Cytoxan– Cytosine arabinoside– Melphalan

Increased treatment morbidity in Bu/Cy vs. TBI/Cy in Ringden et al. Blood 93:2196-2201 1999

Variables of TBIVariables of TBI

• Treatment Time

• Beam Energy

• Total Dose

• Technique (Dose inhomogeneity)

• Fractionation

• Dose Rate

- need spoiler for skin dosing

- up to 16 Gy