Total Body Irradiation Conditioning Regimens in Stem Cell Transplantation

Dusenbery, Kathryn E.; Gerbi, Bruce J.

doi:10.1007/3-540-35665-7_31

Cited by 6 publications

(8 citation statements)

References 50 publications

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“…Less ideally, the measured doses to various anatomic sites varied by as much as 36% among patients (for example, the dose to the esophagus ranged from 79 to 115% of the expected dose). The results of this study are comparable to a report of in vivo dosimetry using TLDs in humans undergoing TBI procedures, where the variation between prescribed and delivered dose ranged from 83% to 143%, with the oral cavity having the “hottest” readings . For most anatomic sites (pooled data from approximately 35 people), the dose range was approximately 20‐25% between the minimum and maximum doses.…”

Section: Discussionsupporting

confidence: 81%

“…Homogenous dose delivery to the whole body is a requirement in TBI. The dosimetric goal of TBI is to achieve ±10% of the prescription dose along the body axis, which was achieved in patients treated with this protocol when doses measured by TLDs placed at various locations were averaged, and was considered acceptable at our institution. Less ideally, the measured doses to various anatomic sites varied by as much as 36% among patients (for example, the dose to the esophagus ranged from 79 to 115% of the expected dose).…”

Section: Discussionmentioning

confidence: 99%

“…Total body photon irradiation (TBI) delivers a specific dose of radiation to the entire body. It is a form of “magna‐field irradiation” (which consists of TBI, half‐body irradiation, total lymphoid irradiation, and body quadrant irradiation), and is a component of interdisciplinary treatment for various disseminated hematologic malignancies and autoimmune diseases . In veterinary medicine, the goals and prescribed dose of TBI vary.…”

Section: Introductionmentioning

confidence: 99%

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Implementation of total body photon irradiation as part of an institutional bone marrow transplant program for the treatment of canine lymphoma and leukemias

Gieger

Nolan

Roback

et al. 2019

Vet Radiology Ultrasound

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A total body irradiation (TBI) protocol was developed to support a bone marrow transplant (BMT) program for the treatment of canine hematologic malignancies. The purpose of this prospective study is to describe implementation of the protocol and resultant dosimetry. Nongraphic manual treatment planning using 6 MV photons, isocentric delivery, 40 × 40 cm field size, wall-mounted lasers to verify positioning, a lucite beam spoiler (without use of bolus material), a dose rate of 8.75 cGy/min at patient isocenter, and a source-to-axis distance of 338 cm were used for TBI. A monitor unit calculation formula was derived using ion chamber measurements and a solid water phantom. Five thermoluminescent dosimeters (TLDs) were used at various anatomic locations in each of four cadaver dogs, to verify fidelity of the monitor unit formula prior to clinical implementation. In vivo dosimetric data were then collected with five TLDs at various anatomic locations in six patients treated with TBI. A total dose of 10 Gy divided into two 5 Gy fractions was delivered approximately 16 h apart, immediately followed by autologous stem cell transplant. The mean difference between prescribed and delivered doses ranged from 99% to 109% for various sites in cadavers, and from 83% to 121% in clinical patients. The mean total body dose in cadavers and clinical patients when whole body dose was estimated by averaging doses measured by variably placed TLDs ranged from 98% to 108% and 93% to 102% of the prescribed dose, respectively, which was considered acceptable. This protocol could be used for institutional implementation of TBI. K E Y W O R D Scadaver, lymphosarcoma, myeloablation, thermoluminescent dosimeter 1 586

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Implementation of total body photon irradiation as part of an institutional bone marrow transplant program for the treatment of canine lymphoma and leukemias

Gieger

Nolan

Roback

et al. 2019

Vet Radiology Ultrasound

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“…The dose inhomogeneity was higher for thoracic bone due to dose restriction to lungs. We were able to reduce dose to lens, kidneys, and liver in addition to lung dose reduction compared to the standard lateral technique that we use in our clinic [6]. The dose reduction to various OARs relative to conventional TBI varied from 30 Á88%.…”

Section: Resultsmentioning

confidence: 94%

Helical tomotherapy targeting total bone marrow – First clinical experience at the University of Minnesota

et al. 2007

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“…Modifications were made over time including the addition of fludarabine (FLU) 35 mg/m 2 per day IV 34 days (1999), the use of thymic shielding 8 during TBI (2003), a reduction of TBI to 300 cGy (2006), and the use of mycophenolate mofetil instead of methylprednisolone for GVHD prophylaxis along with cyclosporine A (2010), as shown in Table 1.…”

Section: Transplant Proceduresmentioning

confidence: 99%

Alternative donor hematopoietic cell transplantation for Fanconi anemia

MacMillan

DeFor

Young³

et al. 2015

Blood

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• With no prior opportunistic infections/transfusions, 5-year survival after alternative donor HCT with TBI 300 cGy, CY, FLU, and ATG was 94%. • Today, most FA patients with standard risk disease are cured of their bone marrow failure by HCT even without an HLA-matched sibling donor.Historically, alternative donor hematopoietic cell transplantation (HCT) for Fanconi anemia (FA) patients resulted in excessive morbidity and mortality. To improve outcomes, we made sequential changes to the HCT conditioning regimen. A total of 130 FA patients (median age, 9.0 years; range, 1-48) underwent alternative donor HCT at the University of Minnesota between 1995 and 2012. All patients received cyclophosphamide (CY), single fraction total body irradiation (TBI), and antithymocyte globulin (ATG) with or without fludarabine (FLU), followed by T-cell-depleted bone marrow or unmanipulated umbilical cord blood transplantation. The addition of FLU enhanced engraftment 3-fold. The incidence of grades 2-4 acute and chronic graft-versus-host disease was 20% and 10%, respectively. Severe toxicity was highest in patients >10 years of age or those with a history of opportunistic infections or transfusions before HCT. Mortality was lowest in patients without a history of opportunistic infection or transfusions and who received conditioning with TBI 300 cGy, CY, FLU, and ATG. These patients had a probability of survival of 94% at 5 years. Alternative donor HCT is now associated with excellent survival for patients without prior opportunistic infections or transfusions and should be considered for all FA patients after the onset of marrow failure. These studies were registered at http://www.clinicaltrials.gov as NCT00005898, NCT00167206, and NCT00352976. (Blood. 2015;125(24):3798-3804)

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Total Body Irradiation Conditioning Regimens in Stem Cell Transplantation

Cited by 6 publications

References 50 publications

Implementation of total body photon irradiation as part of an institutional bone marrow transplant program for the treatment of canine lymphoma and leukemias

Implementation of total body photon irradiation as part of an institutional bone marrow transplant program for the treatment of canine lymphoma and leukemias

Helical tomotherapy targeting total bone marrow – First clinical experience at the University of Minnesota

Alternative donor hematopoietic cell transplantation for Fanconi anemia

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