Hypofractionated Total Marrow and Lymphoid Irradiation for Relapsed/Refractory Leukemia Using Helical Tomotherapy: Workflow and Dosimetric Analysis
- 1Department of Radiation Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China .
Abstract
Purpose: To report the workflow optimization, dosimetric characteristics, and clinical outcomes of hypofractionated total marrow irradiation (TMI) and total marrow and lymphoid irradiation (TMLI) as part of conditioning regimens for patients with relapsed or refractory leukemia undergoing hematopoietic stem cell transplantation (HSCT).
Materials and Methods: Ninety-two patients treated between December 2024 and October 2025 were retrospectively analyzed. Prescription doses ranged from 10.5 to 15.0 Gy, delivered in once-daily fractions of 3.0–4.0 Gy. Patients were grouped by prescription dose (10.5–12.0 Gy, n=72 vs. 14.0–15.0 Gy, n=20). Dosimetric parameters of planning target volumes and organs at risk (OARs) were extracted. Survival outcomes were analyzed using Kaplan–Meier analysis.
Results: Adequate target coverage was achieved in both dose groups, with median planning target volume D95% values of 100.0% and 99.5% for the 10.5–12.0 Gy and 14.0–15.0 Gy groups, respectively. Lung mean doses were limited to 6.2±0.7 Gy and 6.6±0.8 Gy, and mean oral cavity doses were 6.2±1.5 Gy and 5.6±1.0 Gy, respectively. Mean rib doses were intentionally reduced to approximately 10 Gy to prioritize lung sparing. Eighty-seven out of 92 patients successfully underwent HSCT (94.6%), and 8 died of transplant-related causes (8.7%). The overall incidence of chronic graft-versus-host disease was 62.0%. One-year disease-free survival and overall survival were 78.4% and 87.0%, respectively.
Conclusion: Hypofractionated TMI and TMLI are feasible and efficient conditioning approaches for relapsed or refractory leukemia, providing adequate target coverage with effective OAR sparing. The toxicity and clinical outcomes were acceptable.
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BibTeX
@article{ni2026hypofractionated,
title = {{Hypofractionated Total Marrow and Lymphoid Irradiation for Relapsed/Refractory Leukemia Using Helical Tomotherapy: Workflow and Dosimetric Analysis}},
author = {Wenjie Ni and Xiunan Wang and Hui Yang and Jing Zhao and Dongbo Li and Linan Song and Baojin Sun and Xiaofeng Mu},
journal = {Yonsei Medical Journal},
year = {2026},
month = sep,
doi = {10.3349/ymj.2025.0626},
url = {https://doi.org/10.3349/ymj.2025.0626},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Hypofractionated Total Marrow and Lymphoid Irradiation for Relapsed/Refractory Leukemia Using Helical Tomotherapy: Workflow and Dosimetric Analysis
AU - Wenjie Ni
AU - Xiunan Wang
AU - Hui Yang
AU - Jing Zhao
AU - Dongbo Li
AU - Linan Song
AU - Baojin Sun
AU - Xiaofeng Mu
PY - 2026
DA - 2026/09/03
JO - Yonsei Medical Journal
DO - 10.3349/ymj.2025.0626
UR - https://doi.org/10.3349/ymj.2025.0626
AB - Purpose: To report the workflow optimization, dosimetric characteristics, and clinical outcomes of hypofractionated total marrow irradiation (TMI) and total marrow and lymphoid irradiation (TMLI) as part of conditioning regimens for patients with relapsed or refractory leukemia undergoing hematopoietic stem cell transplantation (HSCT). Materials and Methods: Ninety-two patients treated between December 2024 and October 2025 were retrospectively analyzed. Prescription doses ranged from 10.5 to 15.0 Gy, delivered in once-daily fractions of 3.0–4.0 Gy. Patients were grouped by prescription dose (10.5–12.0 Gy, n=72 vs. 14.0–15.0 Gy, n=20). Dosimetric parameters of planning target volumes and organs at risk (OARs) were extracted. Survival outcomes were analyzed using Kaplan–Meier analysis. Results: Adequate target coverage was achieved in both dose groups, with median planning target volume D95% values of 100.0% and 99.5% for the 10.5–12.0 Gy and 14.0–15.0 Gy groups, respectively. Lung mean doses were limited to 6.2±0.7 Gy and 6.6±0.8 Gy, and mean oral cavity doses were 6.2±1.5 Gy and 5.6±1.0 Gy, respectively. Mean rib doses were intentionally reduced to approximately 10 Gy to prioritize lung sparing. Eighty-seven out of 92 patients successfully underwent HSCT (94.6%), and 8 died of transplant-related causes (8.7%). The overall incidence of chronic graft-versus-host disease was 62.0%. One-year disease-free survival and overall survival were 78.4% and 87.0%, respectively. Conclusion: Hypofractionated TMI and TMLI are feasible and efficient conditioning approaches for relapsed or refractory leukemia, providing adequate target coverage with effective OAR sparing. The toxicity and clinical outcomes were acceptable.
SN - 0513-5796
SN - 1976-2437
ER -