Hyperfractionated total body irradiation for bone marrow transplantation I. Early results in leukemia patients

Total body irradiation as preparation for bone marrow transplantation in treatment of acute leukemia and aplastic anemia

In an attempt to improve survival while minimizing toxicity, many bone marrow transplant centers are now studying the use of cytoreduction regimens with an increased amount of radiation in single-dose or fractionated-exposure schedules for patients with leukemia and aplastic anemia. In order to review the current results, the literature prior to September, 1982 was surveyed and data were tabulated for each transplant center regarding the number of patients receiving transplants, diagnoses, cytoreducation regimen, clinical status, revission duration, relapse rate, causes of death and incidence of interstitial pneumonia. The incidence and severity of cataracts, growth failure, hypothyroidism and second malignant neoplasms were noted, and the data obtained from the literature search were updated and expanded by telephone questionnaire when possible. Marked variation in the technique of transplantation was found among the participating institutions, making it difficult to determine the contribution of the various TBI doses, dose rates and fractionation schedules to the efficacy and toxicity of the combined regimen. In order to define the risk-benefit ratio of the various TBI regimens more clearly, prospective controlled, randomized studies will be required.

Total body irradiation before bone marrow transplantation: a review

An increasing number of centres are undertaking BMT and many different techniques are being evolved for TBI. The critical factors to be considered are total dose and dose rate. Conventional single treatments of 1000 cGy (rad) at low dose rates are effective and safe, but alternative fractionated regimes being explored. As few groups treat enough patients to be able to conduct a randomised study, careful and standardised recording of technique and doses given will be important in determining optimum ways of delivering TBI.