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, Jinseok Kim, Hyo Sun Kim, Soo Jeong Kim, Andrew Jihoon Yang, Byung Min Lee, Won Hee Lee, Joongyo Lee, Ki Jung Ahn, Chang-Ok Suh

Research output: Contribution to journalArticle

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 1

Fingerprint

Whole-Body Irradiation
Pneumonia
Lung
Conditioning (Psychology)
Confidence Intervals
Unrelated Donors
Hematopoietic Stem Cell Transplantation
Hematologic Neoplasms
Cyclophosphamide
Siblings
Stem Cells
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Byun, Hwa Kyung ; Yoon, Hong In ; Cho, Jaeho ; Kim, Hyun Ju ; Min, Yoo Hong ; Lyu, Chuhl Joo ; Cheong, June Won ; Kim, Jinseok ; Kim, Hyo Sun ; Kim, Soo Jeong ; Yang, Andrew Jihoon ; Lee, Byung Min ; Lee, Won Hee ; Lee, Joongyo ; Ahn, Ki Jung ; Suh, Chang-Ok. / Factors associated with pulmonary toxicity after myeloablative conditioning using fractionated total body irradiation. In: Radiation Oncology Journal. 2017 ; Vol. 35, No. 3. pp. 257-267.
@article{794eb0b950e446908a7276dab1645879,
title = "Factors associated with pulmonary toxicity after myeloablative conditioning using fractionated total body irradiation",
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.",
author = "Byun, {Hwa Kyung} and Yoon, {Hong In} and Jaeho Cho and Kim, {Hyun Ju} and Min, {Yoo Hong} and Lyu, {Chuhl Joo} and Cheong, {June Won} and Jinseok Kim and Kim, {Hyo Sun} and Kim, {Soo Jeong} and Yang, {Andrew Jihoon} and Lee, {Byung Min} and Lee, {Won Hee} and Joongyo Lee and Ahn, {Ki Jung} and Chang-Ok Suh",
year = "2017",
month = "9",
day = "1",
doi = "10.3857/roj.2017.00290",
language = "English",
volume = "35",
pages = "257--267",
journal = "Radiation Oncology Journal",
issn = "2234-1900",
publisher = "Korean Society for Therapeutic Radiology and Oncology",
number = "3",

}

Byun, HK, Yoon, HI, Cho, J, Kim, HJ, Min, YH, Lyu, CJ, Cheong, JW, Kim, J, Kim, HS, Kim, SJ, Yang, AJ, Lee, BM, Lee, WH, Lee, J, Ahn, KJ & Suh, C-O 2017, 'Factors associated with pulmonary toxicity after myeloablative conditioning using fractionated total body irradiation', Radiation Oncology Journal, vol. 35, no. 3, pp. 257-267. https://doi.org/10.3857/roj.2017.00290

Factors associated with pulmonary toxicity after myeloablative conditioning using fractionated total body irradiation. / Byun, Hwa Kyung; Yoon, Hong In; Cho, Jaeho; Kim, Hyun Ju; Min, Yoo Hong; Lyu, Chuhl Joo; Cheong, June Won; Kim, Jinseok; Kim, Hyo Sun; Kim, Soo Jeong; Yang, Andrew Jihoon; Lee, Byung Min; Lee, Won Hee; Lee, Joongyo; Ahn, Ki Jung; Suh, Chang-Ok.

In: Radiation Oncology Journal, Vol. 35, No. 3, 01.09.2017, p. 257-267.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Factors associated with pulmonary toxicity after myeloablative conditioning using fractionated total body irradiation

AU - Byun, Hwa Kyung

AU - Yoon, Hong In

AU - Cho, Jaeho

AU - Kim, Hyun Ju

AU - Min, Yoo Hong

AU - Lyu, Chuhl Joo

AU - Cheong, June Won

AU - Kim, Jinseok

AU - Kim, Hyo Sun

AU - Kim, Soo Jeong

AU - Yang, Andrew Jihoon

AU - Lee, Byung Min

AU - Lee, Won Hee

AU - Lee, Joongyo

AU - Ahn, Ki Jung

AU - Suh, Chang-Ok

PY - 2017/9/1

Y1 - 2017/9/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85032793699&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032793699&partnerID=8YFLogxK

U2 - 10.3857/roj.2017.00290

DO - 10.3857/roj.2017.00290

M3 - Article

VL - 35

SP - 257

EP - 267

JO - Radiation Oncology Journal

JF - Radiation Oncology Journal

SN - 2234-1900

IS - 3

ER -