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Byun HK, Yoon HI, Cho J, et al. Factors associated with pulmonary toxicity after myeloablative conditioning using fractionated total body irradiation. Radiat Oncol J. 2017;35(3):257-267doi: 10.3857/roj.2017.00290.
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
Byun, Hwa Kyung, et al. "Factors associated with pulmonary toxicity after myeloablative conditioning using fractionated total body irradiation." Radiation oncology journal vol. 35,3 (2017): 257-267. doi: https://doi.org/10.3857/roj.2017.00290
Byun HK, Yoon HI, Cho J, Kim HJ, Min YH, Lyu CJ, Cheong JW, Kim JS, Kim HS, Kim SJ, Yang AJ, Lee BM, Lee WH, Lee J, Ahn KJ, Suh CO. Factors associated with pulmonary toxicity after myeloablative conditioning using fractionated total body irradiation. Radiat Oncol J. 2017 Sep;35(3):257-267. doi: 10.3857/roj.2017.00290. Epub 2017 Sep 29. PMID: 29037020; PMCID: PMC5647754.
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Radiat Oncol J. 2017 Sep;35(3):257-267. doi: 10.3857/roj.2017.00290. Epub 2017 Sep 29.

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

Radiation oncology journal

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

Affiliations

  1. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
  2. Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  3. Division of Pediatric Hemato-oncology, Department of Pediatrics, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea.
  4. Department of Radiation Oncology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

PMID: 29037020 PMCID: PMC5647754 DOI: 10.3857/roj.2017.00290

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.

Keywords: Idiopathic pneumonia syndrome; Infectious pneumonia; Stem cell transplantation; Total body irradiation

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