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KMID : 1038620170350030257
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Radiation Oncology Journal
2017 Volume.35 No. 3 p.257 ~ p.267
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Factors associated with pulmonary toxicity after myeloablative conditioning using fractionated total body irradiation
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Byun Hwa-Kyung
Yoon Hong-In
Cho Jae-Ho
Kim Hyun-Ju
Min Yoo-Hong
Lyu Chuhl-Joo
Cheong June-Won
Kim Jin-Seok
Kim Hyo-Sun
Kim Soo-Jeong
Yang Andrew Ji-Hoon
Lee Byung-Min
Lee Won-Hee
Lee Joon-Gyo
Ahn Ki-Jung
Suh Chang-Ok
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Abstract
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Purpose: Pulmonary toxicities, including infectious pneumonia (IP) and idiopathic pneumonia syndrome (IPS), are serious side effects of total body irradiation (TBI) used for myeloablative conditioning. This study aimed to evaluate clinical factors associated with IP and IPS following TBI.
Materials and Methods: Fifty-eight patients with hematologic malignancies who underwent TBI before allogeneic hematopoietic stem cell transplantation between 2005 and 2014 were reviewed. Most patients (91%) received 12 Gy in 1.5 Gy fractions twice a day. Pulmonary toxicities were diagnosed based on either radiographic evidence or reduced pulmonary function, and were subdivided into IP and IPS based on the presence or absence of concurrent infection.
Results: Pulmonary toxicities developed in 36 patients (62%); 16 (28%) had IP and 20 (34%) had IPS. IP was significantly associated with increased treatment-related mortality (p = 0.028) and decreased survival (p = 0.039). Multivariate analysis revealed that the risk of developing IPS was significantly higher in patients who received stem cells from a matched unrelated donor than from a matched sibling donor (p = 0.021; hazard ratio [HR] = 12.67; 95% confidence interval [CI], 1.46?110.30). Combining other conditioning agents with cyclophosphamide produced a higher tendency to develop IP (p = 0.064; HR = 6.19; 95% CI, 0.90?42.56).
Conclusion: IP and IPS involve different risk factors and distinct pathogeneses that should be considered when planning treatments before and after TBI.
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KEYWORD
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Total body irradiation, Infectious pneumonia, Idiopathic pneumonia syndrome, Stem cell transplantation
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