Outpatient total body irradiation as a component of a comprehensive outpatient transplant program

Abstract

Summary:Outpatient total body irradiation (TBI) as part of a comprehensive outpatient transplant program was delivered to 142 of 167 (85%) consecutive patients receiving TBI-based conditioning therapy. Outpatients received either a single fraction of 500 cGy (110 patients) or 1200 cGy in six fractions over 3 days (32 patients). Patients were assessed daily and were administered oral ondansetron and dexamethasone for prophylaxis of nausea and vomiting as well as i.v. hydration. Accommodation during outpatient TBIbased conditioning was either the patient's home if within 30 min of the hospital, a hotel on the hospital grounds or on a closed hospital ward. None of the 142 patients required admission to the inpatient program during their TBI. There was no difference in 100-day mortality between those receiving TBI as an outpatient (9%) vs as an inpatient (16%). Of four deaths occurring within the first 14 days post transplant, none could be attributed to receiving TBI as an outpatient. Two hundred and six inpatient days were saved through the delivery of outpatient TBI. A comprehensive outpatient program, appropriate patient selection, daily hydration, the use of prophylactic 5HT3 antagonist anti-emetic therapy all contribute to the safe delivery of outpatient TBI. Bone Marrow Transplantation (2002) 29, 667-671. DOI: 10.1038/sj/bmt/1703516 Keywords: outpatient; total body irradiation; stem cell transplantation High-dose therapy and stem cell transplantation is increasingly used in the management of hematological malignancies and other non-malignant disorders. Total body irradiation (TBI)-based regimens are often used as the con-

Performing allogeneic and autologous hematopoietic SCT in the outpatient setting: effects on infectious complications and early transplant outcomes

“…TBI was used in single or fractionated doses. 15,16 Only 19 allogeneic transplant patients (0.05%) received reduced intensity conditioning regimens. …”

Photon Total Body Irradiation for Leukemia Transplantation Therapy: Rationale and Technique Options

“…Even with the use of high-energy x-rays and beam spoilers, the dose uniformity across the patient and from thicker to thinner body sections may not meet the +/-10% criteria (Bredeson et al, 2002). Dose uniformity will improve if opposed beams are used.…”

“…Large variations in patient thickness, e.g. head thickness compared to shoulder thickness, pose problems with dose uniformity that multiple fields cannot resolve (Bredeson et al, 2002). Galvin and D'Angio and Walsh (2000) and Lin and Chu (2001) have described methods for compensating for the lack of patient thickness in certain areas such as the head or feet.…”

“…The patient is rotated or the source of radiation is moved and the remaining dose is provided. Typically, two fields are adequate to provide acceptable dose homogeneity for TBI treatments (Bredeson et al, 2002). Large variations in patient thickness, e.g.…”

“…This variety of leukemias differs based on pathological examination of cell definition. Bredeson et al (2002) provide a summary and results of clinical trials including TBI. Patients with acute myeloid leukemia (AML) have shown to be fairly responsive to stem cell transplants with TBI preparation.…”