scholarly journals Total Body Irradiation as Conditioning Regimen for Haematopoietic Progenitor Cell Transplant: A Case Report and Literature Review

2020 ◽  
pp. 1-4
Author(s):  
Diana Alonso Sánchez ◽  
Diana Alonso Sánchez ◽  
Lloret Sáez- Bravo Marta
Keyword(s):  
At Risk ◽  
Total Body Irradiation ◽  
Progenitor Cell ◽  
Organs At Risk ◽  
Conditioning Regimen ◽  
Three Dimensional ◽  
Cell Transplant ◽  
Haematopoietic Progenitor Cell ◽  
Technological Advances ◽  
Total Body

This case study presents a young adult man with lymphoblastic leukaemia B who required total body irradiation (TBI) as a conditioning regimen for haematopoietic progenitor cell transplant (HPT) as the only curative treatment option for his oncological disease. TBI was carried out with personalised patient immobilisation, three-dimensional simulation, radiophysical planning and dosimetric calculations. A total of 12 Gy were prescribed to be administered twice a day for 3 days in a row by means of volumetric modulated intensity radiotherapy with several isocentres. The best technique for the administration of this radiotherapy is discussed because, although the clinical efficacy of the administration of this body dose has been well known for decades, technological advances have brought us new possibilities when compared to the traditional TBI (bilateral with horizontal photon beam and absorbent screen). These advances include the technique used in this case (multi-isocentre volumetric-radiotherapy), which allows a better doses distribution, reducing the dose in organs at risk (OARs) and producing less toxicity, and therefore allowing the inclusion of patients who would not tolerate a conventional TBI. In addition, this method would allow the dose to be scaled up locally in higher areas at risk with better results in the disease control.

Attenuator design for organs at risk in total body irradiation using a translation technique

2008 ◽  
Vol 35 (5) ◽  
pp. 1663-1669 ◽  
Author(s):  
Marie-Claude Lavallée ◽  
Sylviane Aubin ◽  
Mario Chrétien ◽  
Marie Larochelle ◽  
Luc Beaulieu
Keyword(s):  
At Risk ◽  
Total Body Irradiation ◽  
Organs At Risk ◽  
Translation Technique ◽  
Total Body

scholarly journals Optimized Conformal Total Body Irradiation Among Recipients of TCRαβ/CD19-Depleted Grafts in Pediatric Patients With Hematologic Malignancies: Single-Center Experience

2021 ◽  
Vol 11 ◽  
Author(s):  
Daria Kobyzeva ◽  
Larisa Shelikhova ◽  
Anna Loginova ◽  
Francheska Kanestri ◽  
Diana Tovmasyan ◽  
...  
Keyword(s):  
At Risk ◽  
Radiation Therapy ◽  
Dose Reduction ◽  
Total Body Irradiation ◽  
Pediatric Patients ◽  
Organs At Risk ◽  
Volumetric Modulated Arc Therapy ◽  
Arc Therapy ◽  
Total Body

Total body irradiation (TBI) in combination with chemotherapy is widely used as a conditioning regimen in pediatric and adult hematopoietic stem cell transplantation (HSCT). The combination of TBI with chemotherapy has demonstrated superior survival outcomes in patients with acute lymphoblastic and myeloid leukemia when compared with conditioning regimens based only on chemotherapy. The clinical application of intensity-modulated radiation therapy (IMRT)-based methods (volumetric modulated arc therapy (VMAT) and TomoTherapy) seems to be promising and has been actively used worldwide. The optimized conformal total body irradiation (OC-TBI) method described in this study provides selected dose reduction for organs at risk with respect to the most significant toxicity (lungs, kidneys, lenses). This study included 220 pediatric patients who received OC-TBI with subsequent chemotherapy and allogenic HSCT with TCRαβ/CD19 depletion. A group of 151 patients received OC-TBI using TomoTherapy, and 40 patients received OC-TBI using the Elekta Synergy™ linac with an Agility-MLC (Elekta, Crawley, UK) using volumetric modulated arc therapy (VMAT). Twenty-nine patients received OC-TBI with supplemental simultaneous boost to bone marrow—(SIB to BM) up to 15 Gy: 28 patients (pts)—TomoTherapy; one patient—VMAT. The follow-up duration ranged from 0.3 to 6.4 years (median follow-up, 2.8 years). Overall survival (OS) for all the patients was 63% (95% CI: 56–70), and event-free survival (EFS) was 58% (95% CI: 51–65). The cumulative incidence of transplant-related mortality (TRM) was 10.7% (95% CI: 2.2–16) for all patients. The incidence of early TRM (<100 days) was 5.0% (95% CI: 1.5–8.9), and that of late TRM (>100 days) was 5.7 (95% CI: 1.7–10.2). The main causes of death for all the patients were relapse and infection. The concept of OC-TBI using IMRT VMAT and helical treatment delivery on a TomoTherapy treatment unit provides maximum control of the dose distribution in extended targets with simultaneous dose reduction for organs at risk. This method demonstrated a low incidence of severe side effects after radiation therapy and predictable treatment effectiveness. Our initial experience demonstrates that OC-TBI appears to be a promising technique for the treatment of pediatric patients.

Continuous Infusion Cyclophosphamide and Low Dose Total Body Irradiation (CICy/ldTBI) As a Conditioning Regimen for Tandem Autologous Transplant in Multiple Myeloma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4524-4524
Author(s):  
Michael T. Byrne ◽  
John R. Wingard ◽  
Helen Leather ◽  
Jan S Moreb
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Total Body Irradiation ◽  
Partial Remission ◽  
Conditioning Regimen ◽  
Infectious Complications ◽  
Neutropenic Fever ◽  
Cell Transplant ◽  
Free Survival ◽  
Total Body

Abstract Abstract 4524 Background: Cytotoxic therapy and autologous stem cell transplant (ASCT) remain the mainstay of multiple myeloma (MM) treatment due to both depth of remission as well as relative safety. Improvements in event free survival (EFS) and overall survival (OS) have been reported in patients undergoing tandem transplant. High-dose melphalan (200mg/m2) is one of the most widely used conditioning regimens. Its use, however, is associated with high levels of toxicity with transplant related mortality (TRM) approaching 5% in some studies. When total body irradiation (TBI) is added to melphalan, the risk of infectious complications and TRM increase. Methods: Between June 2001 and July 2011, 21 MM patients underwent tandem ASCT at our institution as part of a prospective phase II clinical study. The patients received cyclophosphamide (CY), busulphan, and etoposide as a conditioning prior to their first ASCT. Patients were assessed after the first ASCT and offered either 2nd tandem ASCT if they achieved ≤ partial remission (PR) or maintenance therapy if they achieve ≥ very good partial remission (VGPR). For patients undergoing tandem ASCT, a novel conditioning regimen was used which included: cyclophosphamide 1500mg/m2/day continuous IV infusion on day -7 through day -4 followed by twice daily TBI at 150 cGy on day -2 and -1. Melphalan 140 mg/m2was substituted for TBI if prior radiation did not allow for further irradiation. The median patient age was 59 years (51–70) and the group consisted of 10 males and 11 females. 17 patients received CICy/ldTBI while 4 patients received CY/melphalan due to prior history of radiation. At the time of the 2ndASCT, 18 patients were in PR, 2 were in VGPR, and 1 had progressive disease (PD). Information regarding the duration of neutropenia, presence of neutropenic fever, infectious complications, and transfusion requirements were collected. Treatment response assessment was based on the uniform response criteria published by The International Myeloma Working Group. Results: Median duration of neutropenia with CICy/ldTBI was 10 days (range, 8–20). 16 patients (76.2%) developed at least one neutropenic fever episode of >38° C. After fever, mild diarrhea was the most common adverse effect (42.9%). 1 patient each (4.8%) developed a limited subdural bleed, pulmonary embolus, neutropenic colitis, bacterial pneumonia, possible fungal pneumonia, hemorrhagic cystitis, and septic shock. 19 patients (90.5%) required transfusion support (red blood cells, platelets, or both) in the post-transplant period. Grade I-II mucositis was seen in 4 patients. All patients were alive at D100. After tandem transplant, 4 patients had entered complete remission (CR) (19.0%). There were 7 VGPR (33.3%) and 6 patients were in PR (28.6%). The median progression free survival (PFS) and overall survival (OS) was 20 and 38 months, respectively. Conclusions: Our results suggest favorable outcomes without TRM in a selected group of high risk myeloma patients who receive CICy/ldTBI as a conditioning regimen prior to their second tandem ASCT. Disclosures: No relevant conflicts of interest to declare.

Hematologic Changes After Total Body Irradiation and Autologous Transplantation of Hematopoietic Peripheral Blood Progenitor Cells in Dogs With Lymphoma

2011 ◽  
Vol 49 (2) ◽  
pp. 341-343 ◽  
Author(s):  
C. Escobar ◽  
C. Grindem ◽  
J. A. Neel ◽  
S. E. Suter
Keyword(s):  
Blood Cell ◽  
Progenitor Cells ◽  
Cell Lines ◽  
Total Body Irradiation ◽  
Peripheral Blood ◽  
Progenitor Cell ◽  
Peripheral Blood Cell ◽  
Peripheral Blood Progenitor Cell ◽  
Cell Transplant ◽  
Total Body

Dogs with and without lymphoma have undergone hematopoietic cell transplantation in a research setting for decades. North Carolina State University is currently treating dogs with B- and T-cell lymphoma in a clinical setting with autologous peripheral blood progenitor cell transplants, using peripheral blood CD34+ progenitor cells harvested using an apheresis machine. Complete blood counts were performed daily for 15 to 19 days posttransplantation to monitor peripheral blood cell nadirs and subsequent CD34+ cell engraftment. This study documents the hematologic toxicities of total body irradiation in 10 dogs and the subsequent recovery of the affected cell lines after peripheral blood progenitor cell transplant, indicating successful CD34+ engraftment. All peripheral blood cell lines, excluding red blood cells, experienced grade 4 toxicities. All dogs had ≥ 500 neutrophils/μl by day 12, while thrombocytopenia persisted for many weeks. All dogs were clinically normal at discharge.

scholarly journals Randomised controlled trial of conditioning regimen for cord blood transplantation for adult myeloid malignancies comparing high-dose cytarabine/cyclophosphamide/total body irradiation with versus without G-CSF priming: G-CONCORD study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040467
Author(s):  
Seitaro Terakura ◽  
Takaaki Konuma ◽  
Masatsugu Tanaka ◽  
Yukiyasu Ozawa ◽  
Makoto Onizuka ◽  
...  
Keyword(s):  
Cord Blood ◽  
Study Protocol ◽  
Total Body Irradiation ◽  
Graft Failure ◽  
Cord Blood Transplantation ◽  
Conditioning Regimen ◽  
High Dose ◽  
Blood Transplantation ◽  
Total Body ◽  
Randomised Controlled

IntroductionA better long-term quality of life after umbilical cord blood transplantation (CBT) is observed compared with transplants from other alternative donors, whereas graft failure and relapses after CBT are still major issues. To minimise graft failure and relapse after CBT, intensification of conditioning by the addition of high-dose cytosine arabinoside (CA) and concomitant continuous use of granulocyte-colony stimulating factor (G-CSF) are reported to convey a significantly better survival after CBT in some retrospective studies. To confirm the effect of G-CSF plus CA combination, in addition to the standard conditioning regimen, cyclophosphamide (CY)/total body irradiation (TBI), we design a randomised controlled study comparing CA/CY/TBI with versus without G-CSF priming (G-CSF combined conditioned cord blood transplantation [G-CONCORD] study).Methods and analysisThis is a multicentre, open-label, randomised phase III study that aimed to compare G-CSF+CA/CY/TBI as a conditioning regimen for CBT with CA/CY/TBI. Patients with acute myeloid leukaemia or myelodysplastic syndrome, aged 16–55 years, are eligible. The target sample size is 160 and the registration period is 4 years. The primary endpoint is the 2-year disease-free survival rate after CBT. The secondary endpoints are overall survival, relapse, non-relapse mortality, acute and chronic graft-versus-host disease, engraftment rate, time to neutrophil recovery, short-term adverse events, incidence of infections and causes of death.This study employs a single one-to-one web-based randomisation between the with-G-CSF versus without-G-CSF groups after patient registration. Combination of high-dose CA and CY/TBI in both groups is used for conditioning.Ethics and disseminationThe study protocol was approved by the central review board, Nagoya University Certified Review Board, after the enforcement of the Clinical Trials Act in Japan. The manuscripts presenting data from this study will be submitted for publication in quality peer-reviewed medical journals. Study findings will be disseminated via presentations at national/international conferences and peer-reviewed journals.Trial registration numbersUMIN000029947 and jRCTs041180059.

scholarly journals Total Body Irradiation for Hematopoietic Stem Cell Transplantation: What Can We Agree on?

2021 ◽  
Vol 28 (1) ◽  
pp. 903-917
Author(s):  
Mitchell Sabloff ◽  
Steven Tisseverasinghe ◽  
Mustafa Ege Babadagli ◽  
Rajiv Samant
Keyword(s):  
Cell Transplantation ◽  
Total Body Irradiation ◽  
Hematopoietic Cell Transplantation ◽  
Conditioning Regimen ◽  
Late Toxicity ◽  
Hepatic Function ◽  
Vascular Supply ◽  
Entire Body ◽  
Hematopoietic Stem ◽  
Total Body

Total body irradiation (TBI), used as part of the conditioning regimen prior to allogeneic and autologous hematopoietic cell transplantation, is the delivery of a relatively homogeneous dose of radiation to the entire body. TBI has a dual role, being cytotoxic and immunosuppressive. This allows it to eliminate disease and create “space” in the marrow while also impairing the immune system from rejecting the foreign donor cells being transplanted. Advantages that TBI may have over chemotherapy alone are that it may achieve greater tumour cytotoxicity and better tissue penetration than chemotherapy as its delivery is independent of vascular supply and physiologic barriers such as renal and hepatic function. Therefore, the so-called “sanctuary” sites such as the central nervous system (CNS), testes, and orbits or other sites with limited blood supply are not off-limits to radiation. Nevertheless, TBI is hampered by challenging logistics of administration, coordination between hematology and radiation oncology departments, increased rates of acute treatment-related morbidity and mortality along with late toxicity to other tissues. Newer technologies and a better understanding of the biology and physics of TBI has allowed the field to develop novel delivery systems which may help to deliver radiation more safely while maintaining its efficacy. However, continued research and collaboration are needed to determine the best approaches for the use of TBI in the future.

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