Total nodal irradiation as part of conditioning for salvage hematopoietic stem cell transplantation in aplastic anemia: A case report

ABSTRACT: Aplastic anemia is a rare hematologic disorder characterized by bone marrow failure and pancytopenia. Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative treatment for eligible patients. In selected cases, radiation-based conditioning strategies, such as total nodal irradiation (TNI), may be incorporated into transplant protocols to enhance immunosuppression and facilitate donor cell engraftment. We present a 30-year-old male patient diagnosed with aplastic anemia in 2021 who underwent allogeneic HSCT from a matched sibling donor in 2023. Salvage transplantation was planned in 2024 due to persistent marrow dysfunction. As part of the conditioning regimen, TNI was administered. TNI was delivered on November 8, 2024 (day-4 prior to transplantation) as a single fraction of 7.5 Gy using volumetric-modulated arc therapy. This case demonstrates the feasibility of TNI as part of a conditioning regimen for salvage HSCT in patients with aplastic anemia.