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Total Body Irradiation Conditioning Regimens in Stem Cell Transplantation

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Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

Abstract

Total body irradiation (TBI) is often used in the preparative regimens of stem cell transplants. The goal of TBI is to administer a specific dose of irradiation to the entire body. Technically this is complicated by limitations in field sizes obtainable on a linear accelerator and the resultant need to treat at extended distances. Variations in patient thickness and decreased attenuation through the lung are additional technical challenges. This chapter describes the techniques in use at the University of Minnesota for accomplishing TBI.

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References

  • AAPM, American Association of Physicists in Medicine (task Group 2) (1986) The physical aspects of total and half body photon irradiation. AAPM Report no 17

    Google Scholar 

  • Abraham R et al (1999) Intensification of the stem cell transplant induction regimen results in increased treatment-related mortality without improved outcome in multiple myeloma. Bone Marrow Transpl 24:1291–1297

    Article  CAS  Google Scholar 

  • Almond PR et al (1999) AAPM’s TG-51 protocol for clinical reference dosimetry of high-energy photon and electron beams. Med Phys 26:1847

    Article  PubMed  CAS  Google Scholar 

  • Aristei C et al (2002) Cataracts in patients receiving stem cell transplantation after conditioning with total body irradiation. Bone Marrow Transpl 29:503–507

    Article  CAS  Google Scholar 

  • Auner HW et al (2002) Infectious complications after autologous hematopoietic stem cell transplantation: comparison of patients with acute myeloid leukemia, malignant lymphoma, and multiple myeloma. Ann Hematol 81:374–377

    Article  PubMed  CAS  Google Scholar 

  • Beavis AW (2004) Is tomotherapy the future of IMRT? Br J Radiol 77:285–295

    Article  PubMed  CAS  Google Scholar 

  • Bhatia S et al (1996) Malignant neoplasms following bone marrow transplantation. Blood 87:3633–3639

    PubMed  CAS  Google Scholar 

  • Borini A, Suriano R, Barberi M, Dal Prato L, Bulletti C (2011) Oocyte donation programs: strategy for improving results. Ann N Y Acad Sci 1221:27–31. doi: 10.1111/j.1749-6632.2010.05934.x

    Google Scholar 

  • Cardozo BL et al (1985) Lung damage following bone marrow transplantation: I. the contribution of irradiation. Int J Radiat Oncol Biol Phys 11:907–914

    Article  PubMed  CAS  Google Scholar 

  • Carlson K et al (1994) Pulmonary function and complications subsequent to autologous bone marrow transplantation. Bone Marrow Transpl 14:805–811

    CAS  Google Scholar 

  • Carruthers SA, Wallington MM (2004) Total body irradiation and pneumonitis risk: a review of outcomes. Br J Cancer 90:2080–2084

    PubMed  CAS  Google Scholar 

  • Cobo A, Meseguer M, Remohí J, Pellicer A (2010) Use of cryo-banked oocytes in an ovum donation programme: a prospective, randomized, controlled, clinical trial. Hum Reprod 25(9):2239–2246 [Epub ahead of print: 30 June 2010]

    Google Scholar 

  • Cole CH et al (1994) Intensive conditioning regimen for bone marrow transplantation in children with high-risk haematological malignancies. Med Pediatr Oncol 23:464–469

    Article  PubMed  CAS  Google Scholar 

  • Colombat P et al (2000) Value of autologous stem cell transplantation with purged bone marrow as first-line therapy for follicular lymphoma with high tumor burden: a GOELAMS phase II study. Bone Marrow Transpl 26:971–977

    Article  CAS  Google Scholar 

  • Confer D, Robinett P (2008) The US National Marrow Donor Program role in unrelated donor hematopoietic cell transplantation. Bone Marrow Transpl 42(Suppl 1):S3–S5

    Article  Google Scholar 

  • Cowen D et al (1992) Regimen-related toxicity in patients undergoing BMT with total body irradiation using a sweeping beam technique. Bone Marrow Transpl 10:515–519

    CAS  Google Scholar 

  • Curtis RE, Rowlings PA, Deeg HJ, Shriner DA, Socie G, Travis LB, Horowitz MM, Witherspoon RP, Hoover RN, Sobocinski KA, Fraumeni JF Jr, Boice JD Jr (1997) Solid cancers after bone marrow transplantation. N Engl J Med 336(13):897–904

    Article  PubMed  CAS  Google Scholar 

  • Dusenbery KE et al (1996) Autologous bone marrow transplantation in acute myeloid leukemia: the University of Minnesota experience. Int J Radiat Oncol Biol Phys 36:335–343

    Article  PubMed  CAS  Google Scholar 

  • Emmanouilides C et al (2003) Localized radiation increases morbidity and mortality after TBI-containing autologous stem cell transplantation in patients with lymphoma. Bone Marrow Transpl 32:863–867

    Article  CAS  Google Scholar 

  • Emminger W et al (1991) Is treatment intensification by adding etoposide and carboplatin to fractionated total body irradiation and melphalan acceptable in children with solid tumors with respect to toxicity? Bone Marrow Transpl 8:119–123

    CAS  Google Scholar 

  • Faraci M et al (2002) Severe neurologic complications after hematopoietic stem cell transplantation in children. Neurology 59:1895–1904 [erratum (2003) 60:1055]

    Article  PubMed  CAS  Google Scholar 

  • Fassas AB, Tricot G (2001) Myelodysplastic syndromes complicating hematopoietic stem cell transplantation. Cancer Treat Res 108:169–184

    Article  PubMed  CAS  Google Scholar 

  • Fehr T, Sykes M (2004) Tolerance induction in clinical transplantation. Transpl Immunol 13(2):117–130

    Article  PubMed  CAS  Google Scholar 

  • Freedman AS et al (1998) High-dose chemoradiotherapy and anti-B-cell monoclonal antibody-purged autologous bone marrow transplantation in mantle-cell lymphoma: no evidence for long-term remission (comment). J Clin Oncol 16:13–18

    PubMed  CAS  Google Scholar 

  • Gatti RA et al (1968) Immunological reconstitution of sex-linked lymphopenic immunological deficiency. Lancet 2:1366–1369

    Article  PubMed  CAS  Google Scholar 

  • Gopal R, Ha CS, Tucker SL, Khouri IF, Giralt SA, Gajewski JL, Andersson BS, Cox JD, Champlin RE (2001) Comparison of two total body irradiation fractionation regimens with respect to acute and late pulmonary toxicity. Cancer. 92(7):1949–1958

    Article  PubMed  CAS  Google Scholar 

  • Gerbi BJ, Dusenbery KE (1995) Design specifications for a treatment stand used for total body photon irradiation with patients in a standing position. Med Dosim 20(1):25–30

    Article  PubMed  CAS  Google Scholar 

  • Hall EJ (2001) Radiobiology for the radiologist, 4th edn. J.B. Lippincott, Philadelphia

    Google Scholar 

  • Hawley RG et al (1996) Retroviral vectors for production of interleukin-12 in the bone marrow to induce a graft-versus-leukemia effect. Ann NY Acad Sci 795:341–345

    Article  PubMed  CAS  Google Scholar 

  • Heslop HE, Rooney CM, Brenner MK (1995) Gene-marking and haemopoietic stem-cell transplantation. Blood Rev 9:220–225

    Article  PubMed  CAS  Google Scholar 

  • Holm K, Nysom K, Rasmussen MH, Hertz H, Jacobsen N, Skakkebaek NE, Krabbe S, Muller J (1990) Growth, growth hormone and final height after BMT Possible recovery of irradiation-induced growth hormone insufficiency. Bone Marrow Transpl 18(1):163–170 1996

    Google Scholar 

  • Holmstrom G, Borgstrom B, Calissendorff B (2002) Cataract in children after bone marrow transplantation: relation to conditioning regimen. Acta Ophthalmol Scand 80(2):211–215 2002 Apr

    Article  PubMed  Google Scholar 

  • Hui SK, Kapatoes J, Fowler J, Henderson D, Olivera G, Manon RR, Gerbi B, Mackie TR, Welsh JS (2005) Feasibility study of helical tomotherapy for total body or total marrow irradiation. Med Phys 32(10):3214–3224

    Article  PubMed  Google Scholar 

  • Iannone R et al (2003) Results of minimally toxic nonmyeloablative transplantation in patients with sickle cell anemia and beta-thalassemia. Biol Blood Marrow Transpl 9:519–528

    Article  Google Scholar 

  • Imamura M, Hashino S, Tanaka J (1996) Graft-versus-leukemia effect and its clinical implications. Leuk Lymphoma 23:477–492

    Article  PubMed  CAS  Google Scholar 

  • Khan FM, Moore VC, Burns DJ (1970) The construction of compensators for cobalt teletherapy. Radiology 96:187–192

    PubMed  CAS  Google Scholar 

  • Khan FM et al (1980) Basic data for dosage calculation and compensation. Int J Radiat Oncol Biol Phys 6:745–751

    Article  PubMed  CAS  Google Scholar 

  • Kim TH et al (1985) Interstitial pneumonitis following total body irradiation for bone marrow transplantation using two different dose rates. Int J Radiat Oncol Biol Phys 11:1285–1291

    Article  PubMed  CAS  Google Scholar 

  • Kirby TH, Hanson WF, Cates DA (1988) Verification of total body photon irradiation dosimetry techniques. Med Phys 15:364–369

    Article  PubMed  CAS  Google Scholar 

  • Klingemann HG (1996) Role of postinduction immunotherapy in acute myeloid leukemia. Leukemia 10(Suppl 1):S21–S22

    PubMed  Google Scholar 

  • Korbling M et al (1991) Autologous blood stem cell (ABSCT) versus purged bone marrow transplantation (pABMT) in standard risk AML: influence of source and cell composition of the autograft on hemopoietic reconstitution and disease-free survival. Bone Marrow Transpl 7:343–349

    CAS  Google Scholar 

  • Krishnamurti L et al (2003) Availability of unrelated donors for hematopoietic stem cell transplantation for hemoglobinopathies. Bone Marrow Transpl 31:547–550

    Article  CAS  Google Scholar 

  • Lane PH et al (1994) Outcome of dialysis for acute renal failure in pediatric bone marrow transplant patients. Bone Marrow Transpl 13:613–617

    CAS  Google Scholar 

  • Lawton CA et al (1989) Technical modifications in hyperfractionated total body irradiation for T-lymphocyte deplete bone marrow transplant. Int J Radiat Oncol Biol Phys 17:319–322

    Article  PubMed  CAS  Google Scholar 

  • Lawton CA et al (1992) Influence of renal shielding on the incidence of late renal dysfunction associated with T-lymphocyte deplete bone marrow transplantation in adult patients. Int J Radiat Oncol Biol Phys 23:681–686

    Article  PubMed  CAS  Google Scholar 

  • Leshem B, Vourka-Karussis U, Slavin S (2000) Correlation between enhancement of graft-versus-leukemia effects following allogeneic bone marrow transplantation by rIL-2 and increased frequency of cytotoxic T-lymphocyte precursors in murine myeloid leukemia. Cytokines Cell Mol Ther 6:141–147

    PubMed  CAS  Google Scholar 

  • Mackie TR et al (2003) Image guidance for precise conformal radiotherapy. Int J Radiat Oncol Biol Phys 56:89–105

    Article  PubMed  Google Scholar 

  • Maeda G, Yokoyama R, Ohtomo K, Takayama J, Beppu Y, Fukuma H, Ohira M (1996) Osteochondroma after total body irradiation in bone marrow transplant recipients: report of two cases. Jpn J Clin Oncol 26(6):480–483

    Article  PubMed  CAS  Google Scholar 

  • Mahmoud HK et al (1985) Bone marrow transplantation for chronic granulocytic leukaemia. Klin Wochenschr 63:560–564

    Article  PubMed  CAS  Google Scholar 

  • Miralbell R et al (1996) Renal toxicity after allogeneic bone marrow transplantation: the combined effects of total-body irradiation and graft-versus-host disease. J Clin Oncol 14:579–585

    PubMed  CAS  Google Scholar 

  • Molls M, Budach V, Bamberg M (1986) Total body irradiation: the lung as critical organ. Strahlenther Onkol 162:226–232

    PubMed  CAS  Google Scholar 

  • Moulder JE, Fish BL (1991) Influence of nephrotoxic drugs on the late renal toxicity associated with bone marrow transplant conditioning regimens. Int J Radiat Oncol Biol Phys 20:333–337

    Article  PubMed  CAS  Google Scholar 

  • Moulder JE, Fish BL, Abrams RA (1987) Renal toxicity following total-body irradiation and syngeneic bone marrow transplantation. Transplantation 43:589–592

    Article  PubMed  CAS  Google Scholar 

  • Parr MD, Messino MJ, McIntyre W (1991) Allogeneic bone marrow transplantation: procedures and complications. Am J Hospital Pharmacy 48:127–137

    CAS  Google Scholar 

  • Peters C et al (2003) Hematopoietic cell transplantation for inherited metabolic diseases: an overview of outcomes and practice guidelines. Bone Marrow Transpl 31:229–239

    Article  CAS  Google Scholar 

  • Petersdorf E et al (1998) Effect of HLA matching on outcome of related and unrelated donor transplantation therapy for chronic myelogenous leukemia. Hematol Oncol Clin North Am 12:107–121

    Article  PubMed  CAS  Google Scholar 

  • Quaranta BP et al (2004) The incidence of testicular recurrence in boys with acute leukemia treated with total body and testicular irradiation and stem cell transplantation. Cancer 101:845–850

    Article  PubMed  Google Scholar 

  • Remberger M et al (2002) The graft-versus-leukaemia effect in haematopoietic stem cell transplantation using unrelated donors. Bone Marrow Transpl 30:761–768

    Article  CAS  Google Scholar 

  • Rubin J et al (2005) Acute neurological complications after hematopoietic stem cell transplantation in children. Pediatr Transpl 9:62–67

    Article  Google Scholar 

  • Schouten HC et al (2000) The CUP trial: a randomized study analyzing the efficacy of high dose therapy and purging in low-grade non-Hodgkin’s lymphoma (NHL). Ann Oncol 11(Suppl 1):91–94

    Article  PubMed  Google Scholar 

  • Shank B et al (1983) Hyperfractionated total body irradiation for bone marrow transplantation. Results in seventy leukemia patients with allogeneic transplants. Int J Radiat Oncol Biol Phys 9:1607–1611

    Article  PubMed  CAS  Google Scholar 

  • Shueng PW, Lin SC, Chong NS, Lee HY, Tien HJ, Wu LJ, Chen CA, Lee JJ, Hsieh CH (2009) Total marrow irradiation with helical tomotherapy for bone marrow transplantation of multiple myeloma: first experience in Asia. Technol Cancer Res Treat 8(1):29–38

    PubMed  Google Scholar 

  • Standke E (1989) Fundamentals, trends and our experiences with total body irradiation (TBI) before bone marrow transplantation (BMT). Folia Haematologica—Internationales Magazin fur Klinische und Morphologische Blutforschung 116:481–485

    CAS  Google Scholar 

  • Steingrimsdottir H et al (2000) Immune reconstitution after autologous hematopoietic stem cell transplantation in relation to underlying disease, type of high-dose therapy and infectious complications. Haematologica 85:832–838

    PubMed  CAS  Google Scholar 

  • Storek J et al (2003) Interleukin-7 improves CD4 T-cell reconstitution after autologous CD34 cell transplantation in monkeys. Blood 101:4209–4218

    Article  PubMed  CAS  Google Scholar 

  • Thomas ED (1997) Pros and cons of stem cell transplantation for autoimmune disease. J Rheumatol 48(Suppl):100–102

    CAS  Google Scholar 

  • Thomas O, Mahe M, Campion L, Bourdin S, Milpied N, Brunet G, Lisbona A, Le Mevel A, Moreau P, Harousseau J, Cuilliere J (2001) Long-term complications of total body irradiation in adults. Int J Radiat Oncol Biol Phys 49(1):125–131

    Article  PubMed  Google Scholar 

  • Valls A et al (1989) Total body irradiation in bone marrow transplantation: fractionated vs single dose. Acute toxicity and preliminary results. Bulletin du Cancer 76:797–804

    PubMed  CAS  Google Scholar 

  • van Besien K et al (2003) Comparison of autologous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma. Blood 102:3521–3529

    Article  PubMed  Google Scholar 

  • Van Dyk J, Keane TJ, Rider WD (1982) Lung density as measured by computerized tomography: implications for radiotherapy. Int J Radiat Oncol Biol Phys 8:1363

    Article  PubMed  Google Scholar 

  • Wong JY, Rosenthal J, Liu A, Schultheiss T, Forman S, Somlo G (2009) Image-guided total-marrow irradiation using helical tomotherapy in patients with multiple myeloma and acute leukemia undergoing hematopoietic cell transplantation. Int J Radiat Oncol Biol Phys 73(1):273–279

    Article  PubMed  Google Scholar 

  • Wood KJ, Prior TG (2001) Gene therapy in transplantation. Curr Opin Mol Therapeut 3:390–398

    CAS  Google Scholar 

  • Zecca M et al (2002) Chronic graft-versus-host disease in children: incidence, risk factors, and impact on outcome. Blood 100:1192–1200

    Article  PubMed  CAS  Google Scholar 

  • Zhu KE, Hu JY, Zhang T, Chen J, Zhong J, Lu YH (2008) Incidence, risks, and outcome of idiopathic pneumonia syndrome early after allogeneic hematopoietic stem cell transplantation. Eur J Haematol 81(6):461–466

    Article  PubMed  Google Scholar 

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Correspondence to Kathryn E. Dusenbery .

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© 2011 Springer-Verlag Berlin Heidelberg

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Dusenbery, K.E., Gerbi, B.J. (2011). Total Body Irradiation Conditioning Regimens in Stem Cell Transplantation. In: Levitt, S., Purdy, J., Perez, C., Poortmans, P. (eds) Technical Basis of Radiation Therapy. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_281

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  • DOI: https://doi.org/10.1007/174_2011_281

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