Andrew Okhuereigbe

02608011

 Types of Bone Marrow Transplants

Total Body Irradiation

ALL Epidemiology/Etiology
ALL Signs/Symptoms
Diagnostic Workup/Pathology
Staging and Grading
Routes of Spread
Surgery

Chemotherapy
Radiation Therapy

Autologous bone marrow transplant.

This procedure is done by removing the patients stem
cells before the patient receives radiation therapy or
chemotherapy. These cells are cryopreserved (frozen)
and then placed back in the body after radiation and
chemotherapy. This leads to the regeneration of
normal blood cells

Allogeneic bone marrow transplant.

In this transplantation, stem cells are removed from a
donor and placed into the patient. The most successful
donors are those whose genes are similar to that of the
patients. Donors usually include parents, brothers,
sisters, children, and other relatives. Blood tests are
done to see how closely the genes match. This is
named a pretransplant evaluation.

Umbilical cord blood transplant

This is a kind of allogeneic transplant where a new
born baby's stems cells are taken from the umbilical
cord of the child immediately following birth. These
stem cells are also cryopreserved and stored for future
use when needed. An advantage of umbilical cord
blood transplantation is that there is a lower need for
blood matching because the blood cells in the
umbilical cord are very immature.

Total body irradiation is usually done before a bone marrow

transplant

 Patient supported 8cm off the linac floor and a

distance of 206 cm from radiation source.

A 1.2cm acrylic beam spoiler is placed 60cm off of floor
place over the patient.
The gantry angle remains at 0. The field size is
40x40cm. The collimator angle is 45.
The energy of the beam is greater or equal to 6mv
photons.
Field size limitations require that the patient height be
limited to 35-45cm

 TBI is usually given to patients with acute

lymphoblastic leukemia.
ALL is the most common childhood cancer. There is a
reported 3,800 new cases yearly.
The exact cause is unknown

 Fatigue

Infection
Easy bleeding
Pain

Swelling
Cough
Rash.

 Two thirds of patients with ALL show anemia and

thrombocytopenia
The higher the count, the poorer the prognosis.
Leukocyte count are also seen with ALL patients and
can vary from low to high.
Once again, the higher the count, the poorer the
prognosis
ALL pathology can be characterized by its unregulated
proliferation of lymphoblast

 The staging system used is the French American

British System. In this system, lymphoblastic leukemia

is divided into three levels
L1 displays a small cell with high nucleus; a regular
cytoplasm ratio or a clefted cell with small
inconspicuous nucleoli.
L2 displays a larger blast cell with irregular nuclear
membrane, one or more prominent nucleoli and
relatively abundance of cytoplasm
L3 displays a large lymphoblast with round to oval
prominent nucleoli and basophilic cytoplasm.

 Liver

lymph nodes
Testes
Brain

 Not at all used in the treatment of ALL

 Remission induction; involve the use of prednisone or

dexamethasone, vincristine and L-asparaginase

Consolidation; uses high- dose intravenous
methotrexate, and L-asparaginase begins after
remission has been achieved
Prophylaxis of overt CNS disease using methotrexate
systemically or intrathecally
Maintenance or continuation therapy until complete
remission for 2 to 3 years

 Patient receives total body radiation of dose total 1200

cGy for 3 consecutive days 200 cGy two times a day.

Patient may also receive dose total 1350 cGy for 3
consecutive days, 150 cGy two times a day.
A mini - TBI schedule is given two days with the first
day bid for a total dose of 600 cGy