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Bone Marrow Transplant

 

TBI

 

Side Effects

When total body irradiation (TBI) is added for preparatory regimen for hematopoeitic cell transplant, there is:

  • Higher incidence of interstitial pneumonitis in cases who have received prior thoracic RT
    • eg TBI + Cyclo 32% vs 5% chemo alone
    • rates of IP incidence and fatalities are similar in both groups if no previous history of thoracic RT

TBI, though generally low dose (standard therapy often involves 12 Gy in 6 fractions over 3 days) affects many organs leading to multiple late effects.

Examples of long term health problems related to radiation therapy component of conditioning regime5:

Region affected by TBI Long-term health Risk
General
    • Increased risk for the development of a second malignant neoplasm2, 3
    • Leukemia – usually AML
    • Solid tumor – often a sarcoma or brain tumor
  • Reduced growth of all the structures within the RT field
    • Significantly worse for young patients
Skeletal
    • Increased risk of osteoporosis (early onset)
    • Increased risk of avascular necrosis
Brain
    • Leukoencephalopathy
    • Long term neurocognitive problems
    • Increased long term risk of cerebrovascular event (stroke)
Eyes
    • Cataracts

Pituitary

Hypothalamus
  • Metabolic syndrome
  • Growth hormone abnormalities
Oral
    • Reduced salivary output with xerostomia and increased risk of dental caries
    • In young children abnormal development of teeth
Thyroid
    • Hypothyroidism
    • Thyroid cancer
Lungs
    • Interstitial disease and pulmonary fibrosis
Heart
  • Increased risk of coronary artery disease
Kidneys
    • Renal damage and dysfunction
  • Hypertension
Gonads
    • Delayed puberty
    • Infertility
    • Early onset of menopause in females
Immune system
    • Increased risk of infection

 

 

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