Biologic Effects of TBI
Purpose To review the biologic effects of total body irradiation (TBI) with regard to leukemic cell kill, immunosuppression, and toxicity to critical normal tissues of concern (lung, lens, kidney, liver).
Methods A review of the radiobiologic TBI literature was done and data analyzed for relationships to TBI parameters such as total dose, dose per fraction, and dose rate. The radiobiologic effects of testicular and splenic ”boost” irradiation were also examined. Comparisons of TBI-containing regimens to chemotherapy-only regimens were also done.
Results Highly fractionated or hyperfractionated TBI regimens to a high total dose have an advantage over single dose TBI in radiobiological studies for achieving a high malignant cell kill and good immunosuppression with minimal organ toxicity. Splenic “boosting” has survival value in at least one subset of CML patients undergoing transplant and testicular “boosting” has decreased testicular relapse. Randomized studies of TBI combined with VP-16 or cyclosphosphamide versus busulfan combined with cyclophosphamide either show an advantage to TBI (in AML in 1st CR) or no difference (in chronic phase CML).
Summary/Conclusion Radiobiological evidence supports the use of highly fractionated TBI to a high total dose (≥ 13 Gy) compared with single dose TBI (10 Gy). Splenic boosts for some CML patients and a testicular boost for all leukemias may offer an advantage when combined with TBI regimens. Randomized studies support the continued use of TBI for AML, and the equivalence of such regimens to chemotherapy-only regimens for CML, but long-term results are pending.
KeywordsBone Marrow Transplantation Chronic Myeloid Leukemia Chronic Myelogenous Leukemia Total Body Irradiation Allogeneic Bone Marrow Transplantation
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