Technical modifications in hyperfractionated total body irradiation for T-lymphocyte deplete bone marrow transplant

Journal Article · Tue Aug 01 00:00:00 EDT 1989 · International Journal of Radiation Oncology, Biology and Physics; (USA)

DOI:https://doi.org/10.1016/0360-3016(89)90446-X· OSTI ID:5543467

Lawton, C A; Barber-Derus, S; Murray, K J; Casper, J T; Ash, R C; Gillin, M T; Wilson, J F ^[1]

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1. Medical College of Wisconsin Affiliated Hospitals, Milwaukee (USA)

The Medical College of Wisconsin implemented a major bone marrow transplant (BMT) program in July 1985. The type of transplants to be focused on were allogeneic T-lymphocyte deplete. Total body irradiation (TBI) was initially patterned after the Memorial method. Patients received total body irradiation in a sitting position at a dose rate of 20-25 cGy/minute with 50% attenuation lung blocks used both anterior/posterior and posterior/anterior. Electron boosting was utilized for the ribs beneath the lung blocks. Occasionally, lower extremity boosting was required because of the sitting position. A dose of 14 Gy was chosen since T-lymphocyte deplete bone marrow transplant data suggest the need for higher total doses to consistently obtain engraftment. This dose was given in 3 equal daily fractions over 3 days following conditioning chemotherapy. Six of 11 patients treated in this manner developed lethal pulmonary events. In response to the pulmonary toxicity, partial lung shielding was increased to 60% attenuation. In the next 107 patients receiving this program of total body irradiation there was a reduced incidence of fatal pulmonary events (10 cases of fatal idiopathic interstitial pneumonitis and 12 cases of fatal pulmonary infections) after a median follow-up of 9 months. This was an obvious improvement over the initial group. A significant level of hepato-renal toxicity was also observed with 14 Gy total body irradiation when no liver or kidney blocking was used. Of the first 20 patients treated, three cases of fatal veno-occlusive disease resulted. Subsequently, a 10% attenuation right sided liver block was added. Five of 98 patients treated with this block have developed fatal hepatic dysfunction, (median follow-up of 7.2 months).

• OSTI ID: 5543467
• Journal Information: International Journal of Radiation Oncology, Biology and Physics; (USA), Vol. 17:2; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.
BONE MARROW CELLS
TRANSPLANTS
KIDNEYS
BIOLOGICAL RADIATION EFFECTS
LIVER
LUNGS
FRACTIONATED IRRADIATION
IRRADIATION PROCEDURES
LEUKEMIA
LYMPHOCYTES
PATIENTS
PNEUMONIA
RADIATION PROTECTION
WHOLE-BODY IRRADIATION
ANIMAL CELLS
BIOLOGICAL EFFECTS
BIOLOGICAL MATERIALS
BLOOD
BLOOD CELLS
BODY
BODY FLUIDS
CONNECTIVE TISSUE CELLS
DIGESTIVE SYSTEM
DISEASES
EXTERNAL IRRADIATION
GLANDS
HEMIC DISEASES
IMMUNE SYSTEM DISEASES
IRRADIATION
LEUKOCYTES
MATERIALS
NEOPLASMS
ORGANS
RADIATION EFFECTS
RESPIRATORY SYSTEM
RESPIRATORY SYSTEM DISEASES
SOMATIC CELLS
560151* - Radiation Effects on Animals- Man