Factors Influencing Pulmonary Toxicity in Children Undergoing Allogeneic Hematopoietic Stem Cell Transplantation in the Setting of Total Body Irradiation-Based Myeloablative Conditioning

Autor: Zhengjia Chen, Natia Esiashvili, Mohammad K. Khan, Chao Zhang, Ann E. Haight, Mustafa Abugideiri, Kuang-Yueh Chiang, Sungjin Kim, Ronica H. Nanda, Charlotte Butker, Elizabeth Butker
Rok vydání: 2016
Předmět:
Male
Cancer Research
medicine.medical_specialty
Transplantation Conditioning
Adolescent
Cyclophosphamide
Pulmonary toxicity
medicine.medical_treatment
Graft vs Host Disease
Hematopoietic stem cell transplantation
Gastroenterology
030218 nuclear medicine & medical imaging
Pulmonary function testing
Young Adult
03 medical and health sciences
0302 clinical medicine
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
Radiology
Nuclear Medicine and imaging
Child
Lung
Etoposide
Chemotherapy
Radiation
business.industry
Incidence
Cytarabine
Hematopoietic Stem Cell Transplantation
Infant
Radiotherapy Dosage
Pneumonia
Total body irradiation
Allografts
Surgery
Transplantation
Oncology
Child
Preschool
030220 oncology & carcinogenesis
Acute Disease
Female
business
Immunosuppressive Agents
Whole-Body Irradiation
medicine.drug
Zdroj: International Journal of Radiation Oncology*Biology*Physics. 94:349-359
ISSN: 0360-3016
DOI: 10.1016/j.ijrobp.2015.10.054
Popis: Purpose This study evaluated factors associated with increased risk of pulmonary toxicity (PT) from any cause in pediatric patients after myeloablative conditioning, using total body irradiation (TBI), followed by allogeneic hematopoietic stem cell transplantation (HSCT). Methods and Materials The records of 129 consecutive pediatric patients (range: 1-21 years of age) who underwent TBI-based myeloablative conditioning for hematologic malignancies at our institution between January 2003 and May 2014 were reviewed. Although total TBI doses ranged from 10.5 to 14 Gy, lung doses were limited to 10 Gy with partial transmission blocks. TBI dose rates ranged from 5.6 cGy/min to 20.9 cGy/min. PT was classified using clinical symptoms, radiographic evidence, and ventilatory defects on pulmonary function tests. Noninfectious (idiopathic) pneumonia syndrome (IPS) was characterized by patients exhibiting PT while demonstrating no signs of infection throughout the follow-up period. Results PT from any cause developed in 70.5% of patients and was significantly associated with increased transplantation-related mortality (TRM) ( P =.03) and decreased overall survival (OS) ( P =.02). IPS developed in 23.3% of patients but was not associated with increased TRM ( P =.6) or decreased OS ( P =.5). Acute graft-versus-host disease (GVHD) significantly affected PT ( P =.001) but did not significantly influence the development of IPS ( P =.4). Infection was a leading cause of PT (75.8%). TBI dose rate significantly affected development of overall PT ( P =.02) and was the sole factor to significantly influence the incidence of IPS ( P =.002). TBI total dose, dose per fraction, disease type, transplantation chemotherapy, age of patient, sex, and donor type did not significantly impact overall PT or IPS. Conclusions A high incidence of PT was noted in this large series of homogeneously treated pediatric patients undergoing TBI for allogeneic HSCT. TBI dose rates affected overall PT and strongly influenced IPS. TBI dose rate is a contributing factor influencing pulmonary toxicity and rates less than 15 cGy/min should be considered to decrease the risk of IPS.
Databáze: OpenAIRE
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