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

Shank, B.; Hopfan, S.; Kim, J.H.; Chu, F.; Grossbard, E.; Kapoor, N.; Kirkpatrick, D.; Dinsmore, R.; Simpson, L.; Reid, A.; Chui, C.; Finegan, D.; O'Reilly, R.J.

doi:10.1016/0360-3016(80)90435-6

Cited by 10 publications

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“…The 1970's and 1980's were characterized by new methods for delivering total body irradiation, particularly the move from single dose to fractionated radiation. Radiobiologic studies had demonstrated that fractionated total body irradiation resulted in enhanced repair of normal compared to leukemia cells with less damage to normal tissues [58][59][60]. Most transplant centers currently use fractionated rather than single dose radiation if radiation is a component of the conditioning regimen.…”

Section: Transplant Regimens For Leukemiamentioning

confidence: 98%

Blood and marrow transplantation: a perspective from the University of Minnesota

Kersey

2007

Immunol Res

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On the occasion of the first meeting of the Robert A. Good Immunology Society in June of 2006, I was asked to provide a perspective on the history and progress of the field of bone marrow transplantation. I was honored to provide this perspective at that meeting and subsequently in this manuscript. This review has a strong University of Minnesota bias, as Minneapolis is a place where important roots in this field were developed. Minnesota is also where I have spent my career in this field learning the excitement of laboratory research beginning as a medical student under Bob Good and Carlos Martinez in 1960, and clinical research in pediatrics under Bill Krivit and Mark Nesbit beginning in 1970. This review is dedicated to two of my recently deceased mentors: Bob Good was a pioneer in so many ways and a true giant in immunology and blood and marrow transplantation. Bill Krivit taught me a great deal about genetic diseases and the critical role of compassion and understanding patients and their families in dealing with fatal illness and new treatments such as bone marrow transplantation that are often risky and themselves may result in suffering and death. My affection for Bob Good and Bill Krivit is unending.

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Section: Transplant Regimens For Leukemiamentioning

confidence: 98%

Blood and marrow transplantation: a perspective from the University of Minnesota

Kersey

2007

Immunol Res

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“…In 30 to 50% of BMT patients with interstitial pneumonitis, a pathologic agent cannot be identified [92]. Evidence suggests that prior TBI is important in the pathogenesis of idiopathic pneumonitis after BMT [53,72]; the incidence is apparently lower when the total radiation doses are fractionated [51,92]. Other potential causes of pulmonary infiltrates are conditioning chemotherapy, leukemic relapse, and granulocyte transfusions [66,69,72].…”

Section: Overview Of Transplantationmentioning

confidence: 99%

“…Fractionation of the total dose is as effective as single-dose therapy and is associated with a reduced incidence of complications [47,51,52]. Interstitial pneumonitis appears to be the major acute toxic effect of TBI [53] and may be fatal in BMT patients [26,53].…”

Section: Overview Of Transplantationmentioning

confidence: 99%

Pediatric Bone Marrow Transplantation: Intensive Care Management

Shannon¹,

Cowan²,

Matthay

1987

J Intensive Care Med

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Bone marrow transplantation (BMT) has assumed increasing importance in the treatment of bone marrow failure, hematopoietic malignancies, congenital immunodeficiencies, and solid tumors. Children undergoing BMT are at high risk for infection and hemorrhage during the period of aplasia. In addition, life-threatening complications of circulatory, pulmonary, gastrointestinal, hepatic, and renal function are common and frequently require intensive supportive care. This review provides an overview of pediatric BMT that focuses on management problems relevant to intensive care. Thorough pretransplantation assessment of underlying organ dysfunction is mandatory before undertaking BMT. The complications associated with preconditioning regimens that use total body irradiation and high doses of ablative chemotherapy are described. Finally, problems involving individual organs are discussed by systems. The challenge of improving the results of BMT in the treatment of childhood malignant and hematopoietic disorders depends, in large part, on successful preventive measures and good management of complications that occur immediately before and within the first 100 days after transplantation. As BMT is indicated for treatment of an increasing number of diseases, more patients will require the care of intensivists familiar with transplantation-related complications. General ConsiderationsBone marrow transplantation (BMT) has assumed increasing importance in the treatment of aplastic anemia [ 1 ], congenital immunodeficiency diseases [2], the leukemias [3-6], and a variety of other malignancies [7]. Because many of these disorders occur during the first two decades of life, children are frequently referred for BMT. Clinical experience has shown that children undergoing BMT tolerate intensive chemoradiotherapy better and have a markedly lower incidence of notable graft-versushost (GVH) disease than their adult counterparts [8,9]. Our purpose in this review is to focus specifically on problems the intensivist is likely to confront in managing children during BMT. BMT is, in itself, a simple procedure. The donor is anesthetized and marrow is harvested by multiple aspirations from the iliac crest. The marrow is filtered mechanically and infused in the form of a blood transfusion. Donor cells migrate to the recipient's bone marrow and active hematopoiesis usually resumes within a few weeks after BMT. Major problems encountered in BMT include the toxicity of intensive conditioning regimens designed to eradicate host immunologic function or residual malignant cells, a prolonged period of pancytopenia and severe immunodeficiency when opportunistic infections are frequently life threatening, and GVH disease in which immunocompetent donor cells attack a variety of host organs. Despite these formidable hurdles, BMT cures 70 to 80% of patients with severe aplastic anemia [10], and excellent results have been observed in the treatment of leukemia and other disorders [2][3][4][5][6][7].

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“…The combination of TBI and chemotherapy demonstrates superior treatment outcomes for BMT conditioning compared with chemotherapy alone. [1][2][3][4][5][6] TBI is effective in immunosuppression, allowing a bone marrow recipient to accept donor marrow cells and allow them to repopulate.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric Study and Verification of Total Body Irradiation Using Helical Tomotherapy and its Comparison to Extended SSD Technique

et al. 2010

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

Cited by 10 publications

References 0 publications

Blood and marrow transplantation: a perspective from the University of Minnesota

Blood and marrow transplantation: a perspective from the University of Minnesota

Pediatric Bone Marrow Transplantation: Intensive Care Management

Dosimetric Study and Verification of Total Body Irradiation Using Helical Tomotherapy and its Comparison to Extended SSD Technique

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