Severe Pulmonary Toxicity After Myeloablative Conditioning Using Total Body Irradiation: An Assessment of Risk Factors

Journal Article · Tue Nov 01 00:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2010.06.058· OSTI ID:21590461

Horwitz, Mitchell E ^[1]; Chino, Junzo P; Craciunescu, Oana; Steffey, Beverly ^[2]; Folz, Rodney J ^[3]; Chao, Nelson J; Rizzieri, David A ^[1]; Marks, Lawrence B ^[4]

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1. Department of Medicine, Division of Cellular Therapy, Duke University Medical Center, Durham, NC (United States)
2. Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States)
3. Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Disorders Medicine, University of Louisville Health Sciences Center, Louisville, KY (United States)
4. Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC (United States)

Purpose: To assess factors associated with severe pulmonary toxicity after myeloablative conditioning using total body irradiation (TBI) followed by allogeneic stem cell transplantation. Methods and Materials: A total of 101 adult patients who underwent TBI-based myeloablative conditioning for hematologic malignancies at Duke University between 1998 and 2008 were reviewed. TBI was combined with high-dose cyclophosphamide, melphalan, fludarabine, or etoposide, depending on the underlying disease. Acute pulmonary toxicity, occurring within 90 days of transplantation, was scored using Common Terminology Criteria for Adverse Events version 3.0. Actuarial overall survival and the cumulative incidence of acute pulmonary toxicity were calculated via the Kaplan-Meier method and compared using a log-rank test. A binary logistic regression analysis was performed to assess factors independently associated with acute severe pulmonary toxicity. Results: The 90-day actuarial risk of developing severe (Grade 3-5) pulmonary toxicity was 33%. Actuarial survival at 90 days was 49% in patients with severe pulmonary toxicity vs. 94% in patients without (p < 0.001). On multivariate analysis, the number of prior chemotherapy regimens was the only factor independently associated with development of severe pulmonary toxicity (odds ratio, 2.7 per regimen). Conclusions: Severe acute pulmonary toxicity is prevalent after TBI-based myeloablative conditioning regimens, occurring in approximately 33% of patients. The number of prior chemotherapy regimens appears to be an important risk factor.

• OSTI ID: 21590461
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 81, Issue 3; Other Information: DOI: 10.1016/j.ijrobp.2010.06.058; PII: S0360-3016(10)00940-5; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ADULTS
CHEMOTHERAPY
ENDOXAN
HAZARDS
MULTIVARIATE ANALYSIS
NEOPLASMS
PNEUMONITIS
RADIATION DOSES
REGRESSION ANALYSIS
STEM CELLS
TOXICITY
WHOLE-BODY IRRADIATION
AGE GROUPS
ALKYLATING AGENTS
ANIMAL CELLS
DISEASES
DOSES
DRUGS
EXTERNAL IRRADIATION
IMMUNOSUPPRESSIVE DRUGS
IRRADIATION
MATHEMATICS
MEDICINE
SOMATIC CELLS
STATISTICS
THERAPY