Biologic and Physical Principles of Total Body Irradiation for Allogeneic and Autologous Bone Marrow Transplantation in Children with Leukemia and Lymphoma
Following Roentgen’s discovery of x-rays in the twilight of the nineteenth century, only a decade or so elapsed before the birth of total body irradiation (TBI), described by Dessauer in 1907 as the “x-ray bath.” In 1927, Teschendorf first described the favorable results he had achieved using TBI in the treatment of the lymphomas. Five years later, Heublein reported on a group of patients with lymphoma, Hodgkin’s disease, and leukemia treated with TBI at Memorial Hospital in New York. In the 1990s, we are still struggling with the nuances of TBI and, in particular, how it is best used in conditioning regimens for bone marrow trasplantation (BMT). The relatively new art of BMT remains fraught with complex issues, and the increasing use of and lymphomas and its emerging role in the treatment of solid tumors have led to a reexamination of the effects of various conditioning regimens, not only in terms of tumor cell kill and prevention of rejection, but also in relation to long-term organ toxicity. Prior to receiving TBI as part of their conditioning regimens for BMT, children have often been exposed to various agents such as cyclophosphamide and cisplatin, causing subclinical damage to such organs as kidney and lung which must be factored into considerations of long-term organ toxicity.
KeywordsAcute Lymphoblastic Leukemia Dose Rate Conditioning Regimen Total Body Irradiation Dose Fractionation
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