Total-body irradiation in the conditioning regimens for autologous stem cell transplantation in lymphoproliferative diseases.

We review the rationale for, and the results of, clinical trials on chemoradiotherapy-based pretransplant regimens for non-Hodgkin's lymphomas, Hodgkin's disease and multiple myeloma. What clearly emerges from this review is the lack of any conclusive evidence that total-body irradiation (TBI)-containing regimens are better than chemotherapy alone in diseases which are considered to be radiosensitive. Due to the variety of pretransplant regimens adopted, the relatively low number of patients enrolled in each trial, and the lack of randomized studies, no one conditioning scheme, with or without TBI, could be identified as superior to another. Only randomized clinical studies will indicate whether TBI-containing regimens are superior to chemotherapy-only regimens and whether TBI and/or involved field radiation therapy have a place in autologous stem cell transplantation programs for lymphoproliferative disorders. And finally, the best TBI dose, schedule, and technique should be defined.