Immediate toxicity during fractionated total body irradiation as conditioning for bone marrow transplantation

Background: Total body irradiation followed by bone marrow transplantation is well established as a part of the conditioning regimen in high dose ther apy. The immediate tolerance of fractionated total body irradiation (FTBI) was investigated prospectively. Methods: From January 1995 to December 1998 162 patients received a FTBI, 6 x2 Gy on 3 consecutive days, lung dose 10 Gy, for allogeneic (n = 112) or a utologous (n = 50) bone marrow transplantation. High dose chemotherapy (mos tly Cyclophosphamide) was administered after the FTBI. A standardized suppo rtive therapy was administered. The immediate toxicity of FTBI was evaluate d prospectively prior to each radiation fraction using a defined questionna ire. Results: Main symptoms distressing the patient during irradiation period we re gastrointestinal symptoms like nausea and emesis. The prevalence of naus ea per fraction increased to 26.1% after the 4th fraction, with a significa nt higher prevalence in children younger than 10 years at 1st and 2nd fract ions. 42.6 and 22.8%, respectively, of all patients complained of nausea an d episodes of emesis, during FTBI. Mild xerostomia and parotiditis were obs erved in 29.9 and 7.1% of all patients. Further gastrointestinal side effec ts during FTBI were loss of appetite in 16.0%, indisposition in 25.3%, mild oesophagitis in 3.7% and diarrhoea in 3.7% of the patients. During FTBI 41 .4% of the patients developed a temporary skin irritation (mild erythema). Pruritus was registered in 3.7% of the patients. Headache was observed in 1 4.8% and Fatigue syndrome in 49.2% of women and 28.3% of men (P < 0.005). Conclusion: FTBI is a well tolerated therapeutic regimen in high dose thera py. The 162 patients investigated revealed no severe immediate side effects . (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.