Fractionated total body irradiation in marrow transplantation for leukaemia

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Abstract
Leukemia patients (30) were prepared for bone marrow transplantation (BMT) with cyclophosphamide (CY) 120 mg/kg followed by total body irradiation (TBI). TBI was delivered in a single dose (sTBI) of 10 Gy [gray], at a dose rate of 0.06-0.08 Gy/min, or in fractionated doses (fTBI) of 33 Gy/day, on each of 3 consecutive days, at the same does rate. Lung shielding was adopted for all patients, in order to obtain a homogeneous dose delivered to the lung and at midline. The first 12 patients were prepared with sTBI and the following 18 with fTBI. fTBI is the single most important factor associated with a lower incidence of IP [interstitial pneumonia] (P = 0.002), a lower mortality from GvHD [graft vs. host disease] and IP (P = 0.03 and 0.001) and a better 100-day survival (P = 0.03). Remission status had no significant influence on GvHD, IP and acute mortality. When compared to MTX [methotrexate], the use of CyA was associated with less GvHD and IP, but when only patients in remission given fTBI were analyzed, this was no longer true. Relapses were mostly influenced by the remission status of the patient at transplant (P = 0.001). These data suggest that fTBI can reduce the acute risks of marrow transplantation in leukemia.

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