Total Body Irradiation

[pcguy2]

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I'm wondering if anyone here could answer this question for me. Or atleast directly me an reliable source. My googling has not led me to anything.

I was watching House M.D., and in one episode, one of the patients needs a bone marrow transplant. So they give the patient total body irradiation to ablate his diseased marrow. But instead of transferring the donor marrow in immediately, they wait a couple of days due to how the story line played out.

I remember one of my professors mentioning that bone marrow transplants need to occur immediately after irradiation. Is this true? Or is waiting a couple of days in an isolated quarunteen safe?

Thanks much!

 

[Palex80]

"Safe" is relative.
One can wait a couple of days or so and substitute the patient with erys and thrombos. You cannot wait forever though cause it is simply very dangerous.
Plus the effect of the total body irradiation in suppressing the patient's immune system so that it can accept the donor's cells fades out the longer you wait after TBI.
If you fail to kill all cancer cells with TBI and chemo then you are hoping that the donor's cells will kill the last few remaining cancer cells after the transplantation. If you wait too long the problem is they may proliferate again so that you still have residual cancer cells in the end.
My colleagues in haematology here usually give the donor cells a couple of hours after the last TBI fraction.

 

[clintpark]

I'm wondering if anyone here could answer this question for me. Or atleast directly me an reliable source. My googling has not led me to anything.

I was watching House M.D., and in one episode, one of the patients needs a bone marrow transplant. So they give the patient total body irradiation to ablate his diseased marrow. But instead of transferring the donor marrow in immediately, they wait a couple of days due to how the story line played out.

I remember one of my professors mentioning that bone marrow transplants need to occur immediately after irradiation. Is this true? Or is waiting a couple of days in an isolated quarunteen safe?

Thanks much!

Usually, the bone marrow ablation is done by combining TBI and conditioning chemotherapy (e.g. busulfan) The conditioning chemo can precede or follow TBI. One advantage of chemo-TBI approach (more common I think) is that the transplant can take place right after TBI because chemo will wash out during the TBI phase --- so overall shorter immunocompromized period. One advantage of TBI-chemo approach is that the patients are stronger during TBI (which can be physically demanding). Patients who get TBI before conditioning chemo will have a few days between TBI and stem cell transplant.

I didn't watch the episode so this may or may not answer your question exactly.

Your professor is right in the sense that once a patient receives TBI, he is committed to a stem cell transplant 'immediately', or he will die. Depending on the regimen, however, it may not necessarily be the next day.

 

[pcguy2]

Thanks a lot. That makes a lot of sense.