Abstract
ObjectivesTo implement a new cost efficacy internal Service for blood component irradiation, we carried out specific procedures and quality assurance reports using the linear accelerators (LINACs) of the Regina Elena Institute (IRE) Radiotherapy Department instead of a dedicated device.MethodsThe technical aspects, quality assurance and regulatory requirements of the internal procedure to set up a local irradiated blood bank have been defined. The LINACs of the IRE Radiotherapy Department were used to deliver a mean dose of 32 Gy and dose accuracy was checked with gafchromic film. The overall time/cost of this procedure was compared with the previous procedure, out-sourcing the irradiation of blood components.ResultsA total of 1996 blood component units were internally irradiated in the first year. Moreover, reducing the overall procedure time by a third. Overall cost/bag of external and internal procedures was approx. 66 € and 11 €, respectively. Thus the average saving of cost/bag was higher than 80%. The use of gafchromic films in all irradiated blood component bags allowed the accuracy of the dose delivered to blood to be checked.ConclusionsBy utilizing LINACs installed in the Radiotherapy Department it is possible to provide an internal blood component irradiation service, capitalizing on internal resources without any inconvenience/discomfort to patients undergoing radiotherapy and satisfying governmental regulatory requirements. The internal irradiation procedures has proven to be safe and feasible, and along with the significant cost/time reduction suggests that it is more advantageous than external procedures.
Highlights
Blood component irradiation is the only proven method of preventing a risk of transfusion-associated graft versus host disease (TA-GVHD) [1].This immunologic reaction of engrafted lymphocytes against the host system is intense and proves fatal in about 90% of affected patients [2].The irradiation of blood components inhibits lymphocyte function avoiding damage to the platelets and other blood fractions
Materials and methods In our Institute, patients at risk for TA-GVHD for whom irradiated blood or products are requested include those with: haematological malignancy or solid tumor (Glioblastoma, Neuroblastoma, Rhabdomyosarcoma); Hodgkin’s disease treated with ablative chemo/ radiotherapy; non-Hodgkin’s lymphoma; acute leukemia (ANLL and ALL), recipients of peripheral blood or bone marrow stem cell transplants (Allogeneic, Autologous), diseases treated with Fludaribine and other potent purine analogues, diseases treated with Cladribine
Planning, commissioning and dosimetry In the implementation phase the isodose distribution was determined within the filled box using Pinnacle TPS (Figure 3)
Summary
Blood component irradiation is the only proven method of preventing a risk of transfusion-associated graft versus host disease (TA-GVHD) [1].This immunologic reaction of engrafted lymphocytes against the host system is intense and proves fatal in about 90% of affected patients [2].The irradiation of blood components inhibits lymphocyte function avoiding damage to the platelets and other blood fractions. Blood component irradiation is the only proven method of preventing a risk of transfusion-associated graft versus host disease (TA-GVHD) [1]. This immunologic reaction of engrafted lymphocytes against the host system is intense and proves fatal in about 90% of affected patients [2]. The irradiation of blood components inhibits lymphocyte function avoiding damage to the platelets and other blood fractions. It renders T-lymphocytes incapable of replication without affecting the function of RBCs, granulocytes, and platelets. The irradiation can be performed using a dedicated blood irradiation device based on Cesium-137 [3] or a Cobalt-60 source, or else an X-ray device.
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