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Review
. 2019 Mar 18;1(1):19-27.
doi: 10.2991/chi.d.190218.002. eCollection 2019 Mar.

Current Status and Perspectives of Irradiation-Based Conditioning Regimens for Patients with Acute Leukemia Undergoing Hematopoietic Stem Cell Transplantation

Rashmika R Potdar  1 , Sorab Gupta  1 , Sebastian Giebel  2 , Bipin N Savani  3 , Gabor Varadi  1 , Arnon Nagler  4 , Slawomir Blamek  5
Affiliations
Review

Current Status and Perspectives of Irradiation-Based Conditioning Regimens for Patients with Acute Leukemia Undergoing Hematopoietic Stem Cell Transplantation

Rashmika R Potdar et al. Clin Hematol Int. .

Abstract

Acute myeloid leukemia and acute lymphoblastic leukemia are the most common indications for allogeneic hematopoietic stem cell transplantation. Total body irradiation (TBI) is an important part of conditioning regimens. TBI-based regimens offer advantages in sanctuary sites but are associated with significant risks of early and late side effects, including pulmonary toxicity, growth retardation, and second malignancy. TBI is also associated with technical problems, such as dose heterogeneity. With evolving techniques in radiation oncology, it is possible to focus the dose to the entire skeleton while sparing the rest of the body. This technique is called total marrow irradiation (TMI). TMI is able to deliver the same or higher doses to bone marrow while reducing toxicity. With the success of TMI, we are moving toward ultra-personalized conditioning. We review the clinical role of the irradiation-based regimens currently in clinical use, emphasizing on their strengths and limitations. Novel technologies with targeted irradiation accompanied by the modern imaging techniques and increased knowledge of the disease process can help us achieve our goal of maximum response with minimum toxicity.

Keywords: Conditioning regimen; Leukemia; Radiation toxicities; Targeted radiation therapy; Total body irradiation (TBI); Total marrow irradiation (TMI).

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Conflict of interest statement

All authors declared no conflicts of interest.

References

    1. Passweg JR, Baldomero H, Bader P, Bonini C, Cesaro S, Dreger S, Duarte RF, Dufour C, Kuball J, Farge-Bancel D, Gennery A, Kroger N, Lanza F, Nagler A, Sureda A, Mohty M. Hematopoietic stem cell transplantation in Europe 2014: more than 40 000 transplants annually. Bone Marrow Transplant. 2016;51(6):786–92. doi: 10.1038/bmt.2016.20. - DOI - PMC - PubMed
    1. Potdar R, Varadi G, Fein J, Labopin M, Nagler A, Shouval R. Shouval, prognostic scoring systems in allogeneic hematopoietic stem cell transplantation: where do we stand? Biol Blood Marrow Transplant. 2017;23(11):1839–46. doi: 10.1016/j.bbmt.2017.07.028. - DOI - PubMed
    1. Giralt S, Ballen K, Rizzo D, Bacigalupo A, Horowitz M, Pasquini M, Sandmaier B. Reduced-intensity conditioning regimen workshop: defining the dose spectrum. Report of a workshop convened by the center for international blood and marrow transplant research. Biol Blood Marrow Transplant. 2009;15(3):367–69. doi: 10.1016/j.bbmt.2008.12.497. - DOI - PMC - PubMed
    1. Atkinson JB, Mahoney FJ, Schwartz IR, Hesch JA. Therapy of acute leukemia by whole-body irradiation and bone marrow transplantation from an identical normal twin. Blood. 1959;14(3):228–34. - PubMed
    1. Thomas ED, Buckner CD, Clift RA, Fefer A, Johnson FL, Neiman PE, Sale GE, Sanders JE, Singer JW, Shulman H, Storb R, Weiden PL. Marrow transplantation for acute nonlymphoblastic leukemia in first remission. N Engl J Med. 1979;301(11):597–99. doi: 10.1056/nejm197909133011109. - DOI - PubMed

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