1. Total Body Irradiation Nancy J Tarbell, MD

2. Contents BMT Background/History TBI technique, dose rate and fractionation Acute Effects Late Effects References

3. Diseases where TBI is used Malignant –Leukemias –Lymphomas –Myelodysplasia –Multiple Myeloma –Pediatric solid tumors –Adult solid tumors Nonmalignant –Aplastic Anemia –Fanconi’s anemia –Wiskott-Aldrich syndrome –other genetic disorders

4. Reasons for BMT in Leukemia Poor prognosis chromosomal abnormalities Prior myelodysplasia Secondary AML Prolonged Induction Relapsing/Refractory Disease

5. Concept of Conditioning Goals –Create “space” in bone marrow for graft –immunosuppression –tumor kill TBI/Cytoxan Busulfan/Cytoxan Cytosine arabinoside Melphalan Increased treatment morbidity in Bu/Cy vs. TBI/Cy in Ringden et al. Blood 93:2196-2201 1999

6. Variables of TBI Treatment Time Beam Energy Total Dose Technique (Dose inhomogeneity) Fractionation Dose Rate - need spoiler for skin dosing - up to 16 Gy

7. Variables of TBI Treatment Time Beam Energy Total Dose Technique (Dose inhomogeneity) Fractionation Dose Rate - need spoiler for skin dosing - up to 16 Gy