# Total body and total marrow irradiation

Source: https://onco.cc/technologies/total-body-irradiation/  
OnCo record `total-body-irradiation` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Irradiating the whole body, or just the bones and marrow, to wipe out the patient's blood system and immune cells before a stem cell transplant.

## Summary

Total body irradiation in several fractions over a few days, combined with chemotherapy, conditions patients for allogeneic transplant by killing residual leukaemia and suppressing the immune system so the donor graft can take. It remains standard for children and young adults with acute lymphoblastic leukaemia, where the FORUM trial showed better survival than chemotherapy-only conditioning. Total marrow and lymphoid irradiation uses IMRT or helical delivery to concentrate the dose on bone marrow and lymph nodes while sparing lungs, eyes and gut, allowing dose escalation or gentler conditioning.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-09-16
- Tags: radiation-wave1
- Principle: A uniform (or marrow-targeted) dose to the entire haematopoietic system eradicates host marrow and immune cells before donor cells are infused.
- Since: 1970
- Strengths: Reaches sanctuary sites drugs miss; Well-proven in paediatric ALL; Marrow-targeted forms spare organs
- Limitations: Lung toxicity and growth effects in children; Infertility and second cancers; Demanding to plan and deliver

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Total_body_irradiation

## Connected records

- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Acute myeloid leukaemia](https://onco.cc/cancers/aml/)
- fronts: [Radiation Therapy](https://onco.cc/fronts/radiation/)
- technologies: [Allogeneic stem cell transplantation](https://onco.cc/technologies/allogeneic-hsct/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/)

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