Total body irradiation

Dosage

Doses of total body irradiation used in bone marrow transplantation typically range from 10 to >12 Gy. For reference, an unfractionated (i.e. single exposure) dose of 4.5 Gy is fatal in 50% of exposed individuals without aggressive medical care. The 10-12 Gy is typically delivered across multiple fractions to minimise toxicities to the patient.

Early research in bone marrow transplantation by E. Donnall Thomas and colleagues demonstrated that this process of splitting TBI into multiple smaller doses resulted in lower toxicity and better outcomes than delivering a single, large dose. The time interval between fractions allows other normal tissues some time to repair some of the damage caused. However, the dosing is still high enough that the ultimate result is the destruction of both the patient's bone marrow (allowing donor marrow to engraft) and any residual cancer cells. Non-myeloablative bone marrow transplantation uses lower doses of total body irradiation, typically about 2 Gy, which do not destroy the host bone marrow but do suppress the host immune system sufficiently to promote donor engraftment.