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

Hwa Kyung Byun, Hong In Yoon, Jaeho Cho, Hyun Ju Kim, Yoo Hong Min, Chuhl Joo Lyu, June Won Cheong, Jin Seok Kim, Hyo Sun Kim, Soo Jeong Kim, Andrew Jihoon Yang, Byung Min Lee, Won Hee Lee, Joongyo Lee, Ki Jung Ahn, Chang Ok Suh

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Abstract

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.

Original languageEnglish
Pages (from-to)257-267
Number of pages11
JournalRadiation Oncology Journal
Volume35
Issue number3
DOIs
Publication statusPublished - 2017 Sep

All Science Journal Classification (ASJC) codes

  • Oncology
  • Radiology Nuclear Medicine and imaging

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    Byun, H. K., Yoon, H. I., Cho, J., Kim, H. J., Min, Y. H., Lyu, C. J., Cheong, J. W., Kim, J. S., Kim, H. S., Kim, S. J., Yang, A. J., Lee, B. M., Lee, W. H., Lee, J., Ahn, K. J., & Suh, C. O. (2017). Factors associated with pulmonary toxicity after myeloablative conditioning using fractionated total body irradiation. Radiation Oncology Journal, 35(3), 257-267. https://doi.org/10.3857/roj.2017.00290