In a significant step moving forward in Precision Radiation Oncology, the Bone Marrow Transplant (BMT) team with the Departments of Haemato-Oncology and Radiation Oncology at Kauvery Cancer Institute, Alwarpet, Chennai have successfully implemented Total Marrow and Lymphoid Irradiation (TMLI) based BMT regimen, positioning the centre among the growing number of institutions in the country leveraging this advanced radiation technique to improve outcomes in hematologic malignancies.
Bone Marrow Transplantation is particularly indicated in high risk relapsed or refractory hematologic malignancies. Launching the TMLI program required institutional commitment to multi-disciplinary planning, training and procurement of appropriate equipment for its successful operational implementation.
What Is TMLI? – Precision in Practice: TMLI is an advanced form of radiotherapy that delivers high-dose radiation specifically to the bone marrow and lymphoid tissues, which are the primary reservoirs of hematologic malignancies.
Using cutting-edge imaging and radiation delivery technologies, TMLI allows for precise sculpting of radiation doses to target areas while sparing healthy organs.
How Is TMLI Performed? – The Personalized Recipe:
The department utilizes custom immobilization, state of the art Linear Accelerator, automated treatment planning algorithms for Volumetric Modulated Arc Therapy (VMAT) radiation planning. The team of Radiation Oncologists meticulously delineate the target volumes which include the entire bone marrow (head to foot), lymph nodal chain, spleen, and sometimes brain, liver and testes (Sanctuary disease sites). Organs-at-risk (OARs) are also contoured for protection. The Medical Physics team uses robust quality assurance protocol to verify dose conformity. The team of Radiation Technologists uses daily on-board imaging for setup and treatment verification prior to each session of treatment ensuring sub-millimetre accuracy even over extended treatment volumes and treatment plan execution.
A green corridor is established for patient transport from the sterile BMT unit till the radiation bunker to minimize risk of infection with the help of facility management team during the time of treatment.
Radiation treatments are delivered over multiple fractions, twice daily with an interval of 6 to 8 hours for 5 days consecutively. The tolerance for the entire course of radiation is very good with minimal side effects; following which Allogenic Bone Marrow Transplant is successfully done two days after the TMLI procedure with good early clinical signs of engraftment post-transplant and no infection during the immunocompromised state.
Results of TMLI – Milestones That Matter: Recovery after the transplant is remarkably smooth. Serial tests are done to confirm complete donor marrow acceptance in the long run indicating a speedy and successful transplant journey with minimal bumps along the way. This is one of the milestones at Kauvery Cancer Institute taking a leap to the next level in oncological practice.
Authored By:
Dr. A. N. Vaidhyswaran
Senior Consultant and Director of Radiation Oncology
About Kauvery Group:
Kauvery Group of Hospitals launched its first hospital more than two decades ago. The founders of Kauvery Hospital were determined on creating world-class healthcare facilities that shall be affordable.
The founding doctors set off on this dream in 1999 with a 30-bedded hospital in Trichy, with a single-minded focus on offering the best-in-class healthcare, with a personal touch. This was a very new concept in a tier 2 city like Trichy which lacked a tertiary care hospital at the time. Today, Kauvery is a multi-specialty hospital chain with 2250+ beds in six locations including Trichy, Chennai, Salem, Hosur, Tirunelveli and Bengaluru. With twelve hospitals and a workforce of over 8000+, Kauvery’s mission is to provide exemplary secondary and tertiary care.
