OUTPATIENT TOTAL-BODY IRRADIATION FOR PEDIATRIC-PATIENTS UNDERGOING STEM-CELL TRANSPLANTATION

We have retrospectively reviewed the ability to safely deliver total b ody irradiation (TBI) in the outpatient setting in 10 pediatric patien ts undergoing stem cell transplantation. Patients had a median age of 14 years (range 9-17 years) with diagnoses that included ALL in second remission, AML in second remission, myelodysplastic syndrome, Ewing's sarcoma, and rhabdomyosarcoma, Patients received a total of 1375 cGy or 1440 cGy given in a hyperfractionated schedule (11 or 12 fractions) over a 4-day period, All children were seen in the outpatient clinic daily during TBI and all were housed within a 20 mile radius of our in stitution during this period. Eight patients achieved good control of nausea and emesis with ondansetron alone while two patients required o ndansetron and diphenhydramine. Nine patients received some form of in travenous hydration during this period (hyperalimentation, fluid bolus es in clinic, or night-time intravenous fluids), One patient maintaine d good hydration with oral intake alone. Only one child required admis sion during this period for persistent nausea and vomiting despite ant iemetics and intravenous fluids, A cost approximation suggests that TB I delivered in the outpatient setting resulted in a saving of approxim ately $2400 per patient. We conclude that TBI administered to children and adolescents in the outpatient setting can be a safe and cost-effe ctive practice.