Implementation of Targeted Total Body Irradiation as a Bone Marrow Transplant Conditioning Regimen: A Review

  • A. LiuEmail author
  • C. Han
  • J. Neylon


Many hematologic malignancies require hematopoietic cell transplantation (HCT) during their course of treatment. Total body irradiation (TBI) has an important role in patients undergoing HCT. TBI induces immunosuppression to prevent the rejection of donor marrow. TBI is also used to eradicate malignant cells in sanctuary organs that are not reached by chemotherapy drugs. However, combined with chemotherapy, TBI is associated with significant toxicities. Targeted TBI has been shown to be able to reduce doses to normal organs, which predicts for reduced toxicities compared with standard TBI. Since the first total marrow irradiation (TMI) patient using intensity-modulated radiation therapy (IMRT) on Helical TomoTherapy was treated in 2005, many studies have been conducted and published. In this article, we review the practical aspects of targeted TBI implementation starting from patient positioning, immobilization, CT simulation, target delineation, plan optimization, dosimetry comparison, and quality assurance to treatment delivery. Recommendations on practical implementation to deliver targeted TBI are made with the intent to improve the planning and treatment process and to establish consistent and comparable treatment standards among institutions.


Total body irradiation (TBI) Total marrow irradiation (TMI) Total marrow lymphoid irradiation (TMLI) Helical TomoTherapy Volumetric modulated arc therapy (VMAT) TMI Planning TMI protocol 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Radiation OncologyCity of Hope Medical CenterDuarteUSA

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