Method of total marrow irradiation (TMI)

Abstract

Allogenic and autologous hematopoietic stem cell transplantation (HSCT) is widely used for the treatment of manymyeloid and lymphoid malignancies. Conditioning precedes bone marrow transplantation. Chemotherapy alone or with radiotherapy (TBI — total bone marrow irradiation) are used to conditioning. The proven efficacy of TBI means that the use of this conditioning is essential even though it is limited by adverse effects: both acute and late toxicity. New methods of irradiation are desirable. In our Institution we have performed a phase II study (ClinicalTrials.gov NCT01665014) from 2012 for patients with multiple plasmocytoma. The TMI we use is a modified form of TBI. It seems to be especially appropriate for the treatment of neoplasms located mainly or only in bone marrow (multiple myeloma, acute leukemias). Limitation of irradiated volumes only to bones probably will reduce a toxicity of treatment. Currently there are no internationally agreed methodological guidelines for TMI. Also there are only few publications on TMI. The aim of this paper is to introduce the methodology of TMI used in our department.