Radiation Oncology Journal

  • 제35권3호
  • /
  • Pages.257-267
  • /
  • 2017
  • /
  • 2234-1900(pISSN)
  • /
  • 2234-3156(eISSN)
대한방사선종양학회 (The Korean Society for Radiation Oncology)
권호 표지
DOI QR코드

DOI QR Code

Factors associated with pulmonary toxicity after myeloablative conditioning using fractionated total body irradiation

  • Byun, Hwa Kyung (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Yoon, Hong In (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Cho, Jaeho (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Kim, Hyun Ju (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Min, Yoo Hong (Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Lyu, Chuhl Joo (Division of Pediatric Hemato-oncology, Department of Pediatrics, Yonsei University Health System, Yonsei University College of Medicine) ;
  • Cheong, June-Won (Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Jin Seok (Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Hyo Sun (Division of Pediatric Hemato-oncology, Department of Pediatrics, Yonsei University Health System, Yonsei University College of Medicine) ;
  • Kim, Soo-Jeong (Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Yang, Andrew Jihoon (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Lee, Byung Min (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Lee, Won Hee (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Lee, Joongyo (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Ahn, Ki Jung (Department of Radiation Oncology, Inje University Busan Paik Hospital, Inje University College of Medicine) ;
  • Suh, Chang-Ok (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine)
  • 투고 : 2017.05.29
  • 심사 : 2017.08.16
  • 발행 : 2017.09.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

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.

키워드

참고문헌

  1. Hartman AR, Williams SF, Dillon JJ. Survival, diseasefree survival and adverse effects of conditioning for allogeneic bone marrow transplantation with busulfan/cyclophosphamide vs total body irradiation: a meta-analysis. Bone Marrow Transplant 1998;22:439-43. https://doi.org/10.1038/sj.bmt.1701334
  2. Socie G, Clift RA, Blaise D, et al. Busulfan plus cyclophosphamide compared with total-body irradiation plus cyclophosphamide before marrow transplantation for myeloid leukemia: long-term follow-up of 4 randomized studies. Blood 2001;98:3569-74. https://doi.org/10.1182/blood.V98.13.3569
  3. Chaillet MP, Cosset JM, Socie G, et al. Prospective study of the clinical symptoms of therapeutic whole body irradiation. Health Phys 1993;64:370-4. https://doi.org/10.1097/00004032-199304000-00003
  4. Ozsahin M, Pene F, Cosset JM, Laugier A. Morbidity after total body irradiation. Semin Radiat Oncol 1994;4:95-102. https://doi.org/10.1016/S1053-4296(05)80036-0
  5. Neiman PE, Reeves W, Ray G, et al. A prospective analysis interstitial pneumonia and opportunistic viral infection among recipients of allogeneic bone marrow grafts. J Infect Dis 1977;136:754-67. https://doi.org/10.1093/infdis/136.6.754
  6. Thomas ED, Buckner CD, Banaji M, et al. One hundred patients with acute leukemia treated by chemotherapy, total body irradiation, and allogeneic marrow transplantation. Blood 1977;49:511-33.
  7. Clark JG, Hansen JA, Hertz MI, Parkman R, Jensen L, Peavy HH. NHLBI workshop summary. Idiopathic pneumonia syndrome after bone marrow transplantation. Am Rev Respir Dis 1993;147(6 Pt 1):1601-6. https://doi.org/10.1164/ajrccm/147.6_Pt_1.1601
  8. Morgan TL, Falk PM, Kogut N, Shah KH, Tome M, Kagan AR. A comparison of single-dose and fractionated total-body irradiation on the development of pneumonitis following bone marrow transplantation. Int J Radiat Oncol Biol Phys 1996;36:61-6. https://doi.org/10.1016/S0360-3016(96)00246-5
  9. Kelsey CR, Horwitz ME, Chino JP, et al. Severe pulmonary toxicity after myeloablative conditioning using total body irradiation: an assessment of risk factors. Int J Radiat Oncol Biol Phys 2011;81:812-8. https://doi.org/10.1016/j.ijrobp.2010.06.058
  10. Abugideiri M, Nanda RH, Butker C, et al. Factors influencing pulmonary toxicity in children undergoing allogeneic hematopoietic stem cell transplantation in the setting of total body irradiation-based myeloablative conditioning. Int J Radiat Oncol Biol Phys 2016;94:349-59. https://doi.org/10.1016/j.ijrobp.2015.10.054
  11. Savani BN, Montero A, Wu C, et al. Prediction and prevention of transplant-related mortality from pulmonary causes after total body irradiation and allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2005;11:223-30. https://doi.org/10.1016/j.bbmt.2004.12.328
  12. Ethier MC, Blanco E, Lehrnbecher T, Sung L. Lack of clarity in the definition of treatment-related mortality: pediatric acute leukemia and adult acute promyelocytic leukemia as examples. Blood 2011;118:5080-3. https://doi.org/10.1182/blood-2011-07-363333
  13. Park J, Choi EK, Kim JH, et al. Effects of total body irradiationbased conditioning on allogeneic stem cell transplantation for pediatric acute leukemia: a single-institution study. Radiat Oncol J 2014;32:198-207. https://doi.org/10.3857/roj.2014.32.3.198
  14. Glucksberg H, Storb R, Fefer A, et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation 1974;18:295-304. https://doi.org/10.1097/00007890-197410000-00001
  15. Fielding AK, Rowe JM, Richards SM, et al. Prospective outcome data on 267 unselected adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia confirms superiority of allogeneic transplantation over chemotherapy in the pre-imatinib era: results from the International ALL Trial MRC UKALLXII/ECOG2993. Blood 2009;113:4489-96. https://doi.org/10.1182/blood-2009-01-199380
  16. Ho VT, Weller E, Lee SJ, Alyea EP, Antin JH, Soiffer RJ. Prognostic factors for early severe pulmonary complications after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2001;7:223-9. https://doi.org/10.1053/bbmt.2001.v7.pm11349809
  17. Chen CS, Boeckh M, Seidel K, et al. Incidence, risk factors, and mortality from pneumonia developing late after hematopoietic stem cell transplantation. Bone Marrow Transplant 2003;32:515-22. https://doi.org/10.1038/sj.bmt.1704162
  18. Pino y Torres JL, Bross DS, Lam WC, Wharam MD, Santos GW, Order SE. Risk factors in interstitial pneumonitis following allogenic bone marrow transplantation. Int J Radiat Oncol Biol Phys 1982;8:1301-7. https://doi.org/10.1016/0360-3016(82)90579-X
  19. Carruthers SA, Wallington MM. Total body irradiation and pneumonitis risk: a review of outcomes. Br J Cancer 2004;90:2080-4. https://doi.org/10.1038/sj.bjc.6601751
  20. Zhang MJ, Davies SM, Camitta BM, et al. Comparison of outcomes after HLA-matched sibling and unrelated donor transplantation for children with high-risk acute lymphoblastic leukemia. Biol Blood Marrow Transplant 2012;18:1204-10. https://doi.org/10.1016/j.bbmt.2012.01.007
  21. Toruner M, Loftus EV Jr, Harmsen WS, et al. Risk factors for opportunistic infections in patients with inflammatory bowel disease. Gastroenterology 2008;134:929-36. https://doi.org/10.1053/j.gastro.2008.01.012
  22. Mohty M, Jacot W, Faucher C, et al. Infectious complications following allogeneic HLA-identical sibling transplantation with antithymocyte globulin-based reduced intensity preparative regimen. Leukemia 2003;17:2168-77. https://doi.org/10.1038/sj.leu.2403105
  23. Martino R, Caballero MD, Canals C, et al. Reduced-intensity conditioning reduces the risk of severe infections after allogeneic peripheral blood stem cell transplantation. Bone Marrow Transplant 2001;28:341-7. https://doi.org/10.1038/sj.bmt.1703150
  24. Hamadani M, Blum W, Phillips G, et al. Improved nonrelapse mortality and infection rate with lower dose of antithymocyte globulin in patients undergoing reduced-intensity conditioning allogeneic transplantation for hematologic malignancies. Biol Blood Marrow Transplant 2009;15:1422-30. https://doi.org/10.1016/j.bbmt.2009.07.006
  25. Wolden SL, Rabinovitch RA, Bittner NH, et al. American College of Radiology (ACR) and American Society for Radiation Oncology (ASTRO) practice guideline for the performance of total body irradiation (TBI). Am J Clin Oncol 2013;36:97-101. https://doi.org/10.1097/COC.0b013e31826e0528
  26. Belkacemi Y, Pene F, Touboul E, et al. Total-body irradiation before bone marrow transplantation for acute leukemia in first or second complete remission. Results and prognostic factors in 326 consecutive patients. Strahlenther Onkol 1998;174:92-104. https://doi.org/10.1007/BF03038482
  27. Girinsky T, Benhamou E, Bourhis JH, et al. Prospective randomized comparison of single-dose versus hyperfractionated total-body irradiation in patients with hematologic malignancies. J Clin Oncol 2000;18:981-6. https://doi.org/10.1200/JCO.2000.18.5.981
  28. Ozsahin M, Pene F, Touboul E, et al. Total-body irradiation before bone marrow transplantation: results of two randomized instantaneous dose rates in 157 patients. Cancer 1992;69:2853-65. https://doi.org/10.1002/1097-0142(19920601)69:11<2853::AID-CNCR2820691135>3.0.CO;2-2
  29. Jagasia M, Arora M, Flowers ME, et al. Risk factors for acute GVHD and survival after hematopoietic cell transplantation. Blood 2012;119:296-307. https://doi.org/10.1182/blood-2011-06-364265

피인용 문헌

  1. Feasibility of hybrid TomoHelical- and TomoDirect-based volumetric gradient matching technique for total body irradiation vol.14, pp.1, 2019, https://doi.org/10.1186/s13014-019-1435-5
  2. Pulmonary Toxicity after Total Body Irradiation-An Underrated Complication? Estimation of Risk via Normal Tissue Complication Probability Calculations and Correlation with Clinical Data vol.13, pp.12, 2017, https://doi.org/10.3390/cancers13122946
  3. The Burden of Survivorship on Hematological Patients-Long-Term Analysis of Toxicities after Total Body Irradiation and Allogeneic Stem Cell Transplantation vol.13, pp.22, 2021, https://doi.org/10.3390/cancers13225640