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This is a Literature Review study (also classified as: Observational).

August 22, 2025Open Access

Total Body Irradiation in Haematopoietic Stem Cell Transplantation: A Comprehensive Literature Review and Institutional Experience from the Policlinico of Catania

MGMaria Chiara Lo GrecoUniversity of Messina RMRoberto MilazzottoUniversity of Catania GAGrazia AcquavivaPoliclinico Universitario di Catania

Key Points

Fractionated myeloablative regimens show superior overall survival and lower severe graft-versus-host disease rates compared to single doses, improving treatment outcomes.
In an institutional experience with 77 patients, 92% completed a 12-Gy regimen with minimal side effects, indicating effective management of TBI.
Conformal planning effectively reduces lung radiation dose without hindering engraftment, shown by successful outcomes in patients treated at our institution.
Research into TBI protocols continues, with trials exploring higher doses and alternatives for selected patients, indicating a shift towards personalized treatment.

Abstract

Background and Objectives: Total body irradiation (TBI) remains a cornerstone of conditioning for allogeneic haematopoietic stem-cell transplantation (HSCT). Whereas early research debated the need for irradiation, contemporary investigations focus on optimising dose, fractionation and delivery techniques. Material and Methods: We synthesised six decades of evidence, spanning from single-fraction cobalt treatments to modern helical tomotherapy and intensity-modulated total-marrow/lymphoid irradiation (TMI/TMLI). To complement the literature, we reported our institutional experience on 77 paediatric and adult recipients treated with conventional extended-source-to-skin-distance TBI at the University Hospital Policlinico “G. Rodolico–San Marco” between 2015 and 2025. Results: According to literature data, fractionated myeloablative schedules, typically 12 Gy in 6 fractions, provide superior overall survival and lower rates of severe graft-versus-host disease (GVHD) compared with historical single-dose regimens. Conversely, reduced-intensity protocols of 2–4 Gy broaden HSCT eligibility for older or comorbid patients with acceptable toxicity. Conformal planning reliably decreases mean lung dose without compromising engraftment, and early-phase trials are testing selective escalation to 16–20 Gy or omission of TBI in molecularly favourable cases. With regard to our institutional retrospective series, 92% of patients completed a 12-Gy regimen with only transient grade 1–2 nausea, fatigue or hypotension; all transplanted patients engrafted, and no grade ≥ 3 radiation pneumonitis occurred. Conclusions: Collectively, the published evidence and our experience support TBI as an irreplaceable component of HSCT conditioning and suggest that coupling it with advanced imaging, organ-sparing dosimetry and molecular response monitoring can deliver safer, more personalised therapy in the coming decade.

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