Radiotherapeutic palliation of bone marrow diseases—leukemia and multiple myeloma

Therapies for diseases of the bone marrow are rapidly evolving with recent improvements in multi-agent chemotherapeutic regimens, immunotherapies, targeted agents, and hematopoietic stem cell transplants. In the recent era of biologically directed treatments and cellular therapies, long-term remissions are possible even in patients with disease progression following salvage systemic therapies or transplantation. Multidisciplinary discussion with medical oncologists is imperative to review the perceived treatment intent and the myriad of available systemic options for patients. Many of the malignant cells in bone marrow diseases are exquisitely sensitive to radiotherapy. In this chapter, we review how this radiodensity can be harnessed in the palliative setting where ultra-low doses of radiotherapy can achieve the desired goals for patients with leukemia and multiple myeloma. We review the available literature on the use of radiotherapy for local manifestations of these diseases and consider commonly encountered clinical scenarios.