Total body irradiation before allogeneic bone marrow transplantation: is more dose better?
OBJECTIVE
This study was performed to retrospectively assess the potential influence of total-body irradiation (TBI) dose on overall survival in patients undergoing allogeneic bone-marrow transplants (BMT) for hematologic malignancies.


METHODS
Between October 1984 and December 1996, 116 patients were conditioned with high-dose chemotherapy and fractionated TBI before allogeneic BMT. The median age was 34 years (range 3-60). The TBI dose was given in 6 fractions, twice-a-day, over 3 days before BMT. The total dose was 10 Gy in 24 patients, 12 Gy in 66 patients, and 13.5 Gy in 26 patients.


RESULTS
TBI dose was inversely correlated with overall survival. Five-year survival was 62% for patients conditioned with 10 Gy, 55% for patients conditioned with 12 Gy, and 46% for patients conditioned with 13.5 Gy. Age at BMT was also independently correlated with survival, with the best outcome for patients < 40 years old.


CONCLUSIONS
A TBI dose (fractionated) > 10 Gy may not necessarily be associated with a better outcome in patients undergoing allogeneic bone-marrow transplant for hematologic malignancies.
Oncology Institute of Southern Switzerland, San Giovanni Hospital, Bellinzona, Switzerland.
S
S
Bieri
C
C
Helg
B
B
Chapuis
R
R
Miralbell
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000379:methods / Q000401:mortality*; D002066:Busulfan / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use; D003630:Daunorubicin / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality* / Q000628:therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality* / Q000628:therapy; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013852:Thiotepa / Q000627:therapeutic use; D019172:Transplantation Conditioning / Q000379:methods / Q000401:mortality*; D014184:Transplantation, Homologous; D014916:Whole-Body Irradiation / Q000379:methods / Q000401:mortality*
D011838:Radiation-Sensitizing Agents; D003561:Cytarabine; D005047:Etoposide; D003520:Cyclophosphamide; D013852:Thiotepa; D002066:Busulfan; D003630:Daunorubicin