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Total Body Irradiation

Total Body Irradiation. Nancy J Tarbell, MD. Contents. BMT Background/History TBI technique, dose rate and fractionation Acute Effects Late Effects References. Malignant Leukemias Lymphomas Myelodysplasia Multiple Myeloma Pediatric solid tumors Adult solid tumors. Nonmalignant

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Total Body Irradiation

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  1. Total Body Irradiation Nancy J Tarbell, MD

  2. Contents • BMT Background/History • TBI technique, dose rate and fractionation • Acute Effects • Late Effects • References

  3. Malignant Leukemias Lymphomas Myelodysplasia Multiple Myeloma Pediatric solid tumors Adult solid tumors Nonmalignant Aplastic Anemia Fanconi’s anemia Wiskott-Aldrich syndrome other genetic disorders Diseases where TBI is used

  4. Reasons for BMT in Leukemia • Poor prognosis chromosomal abnormalities • Prior myelodysplasia • Secondary AML • Prolonged Induction • Relapsing/Refractory Disease

  5. Concept 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

  6. Variables of TBI • Treatment Time • Beam Energy • Total Dose • Technique (Dose inhomogeneity) • Fractionation • Dose Rate - need spoiler for skin dosing - up to 16 Gy

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