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Post-Transplant Events

Pulmonary function following total body irradiation (with or without lung shielding) and allogeneic peripheral blood stem cell transplant

Bone Marrow Transplantation volume 40, pages 573–578 (2007)Cite this article

Abstract

Our purpose was to determine if total body irradiation (TBI) with lung dose reduction protects against subsequent radiation-induced deterioration in pulmonary function. Between July 1997 and August 2004, 181 consecutive patients with hematologic malignancies received fractionated TBI before allogeneic peripheral blood stem cell transplant. The first 89 patients were treated to a total dose of 13.6 Gy. Thereafter, total body dose was decreased to 12 Gy with lung dose reduction to 9 or 6 Gy. All patients underwent pulmonary function test evaluation before treatment, 90 days post-treatment, then annually. Median follow-up was 24.0 months. Eighty-nine patients were treated with lung shielding, and 92 without. At 1-year post transplant, there was a small but significant difference in lung volume measurements between patients with lung shielding and those without. This was not observed at the 2-year time point. When stratified by good (>100% predicted) or poor (⩽100% predicted) baseline lung function, patients with poor function demonstrated protection at 1 year with lung shielding, while those with good initial lung function did not. TBI with or without lung dose reduction has a small but statistically significant effect on pulmonary function measured at 1 year but not 2 years post irradiation.

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References

  1. Shim BY, Lee MA, Byun JH, Roh SY, Song CW, Park JN et al. High dose chemotherapy and autologous stem cell transplantation for poor risk and recurrent non-Hodgkin's lymphoma: a single-center experience of 50 patients. Korean J Intern Med 2004; 19: 114–120.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Reimer P, Schertlin T, Rudiger T, Geissinger E, Roth S, Kunzmann V et al. Myeloablative radiochemotherapy followed by autologous peripheral blood stem cell transplantation as first-line therapy in peripheral T-cell lymphomas: first results of a prospective multicenter study. Hematol J 2004; 5: 304–311.

    Article  CAS  PubMed  Google Scholar 

  3. Kang HJ, Shin HY, Choi HS, Han KS, Ahn HS . Autologous peripheral blood stem cell transplantation with BCVAC conditioning in childhood acute myeloid leukemia. Bone Marrow Transplant 2004; 33: 471–476.

    Article  CAS  PubMed  Google Scholar 

  4. Russell-Jones R, Child F, Olavarria E, Whittaker S, Spittle M, Apperley J . Autologous peripheral blood stem cell transplantation in tumor-stage mycosis fungoides: predictors of disease-free survival. Ann NY Acad Sci 2001; 941: 147–154.

    Article  CAS  PubMed  Google Scholar 

  5. Varterasian M, Janakiraman N, Karanes C, Abella E, Uberti J, Dragovic J et al. Transplantation in patients with multiple myeloma: a multicenter comparative analysis of peripheral blood stem cell and allogeneic transplant. Am J Clin Oncol 1997; 20: 462–466.

    Article  CAS  PubMed  Google Scholar 

  6. Giralt SA, LeMaistre CF, Vriesendorp HM, Andersson BS, Dimopoulos M, Gajewski J et al. Etoposide, cyclophosphamide, total-body irradiation, and allogeneic bone marrow transplantation for hematologic malignancies. J Clin Oncol 1994; 12: 1923–1930.

    Article  CAS  PubMed  Google Scholar 

  7. Thomas ED . Total body irradiation regimens for marrow grafting. Int J Radiat Oncol Biol Phys 1990; 19: 1285–1288.

    Article  CAS  PubMed  Google Scholar 

  8. Advisory Committee of the International Bone Marrow Transplant Registry. Report from the International Bone Marrow Transplant Registry. Bone Marrow Transplant 1989; 4: 221–228.

    Google Scholar 

  9. McAfee SL, Powell SN, Colby C, Spitzer TR . Dose-escalated total body irradiation and autologous stem cell transplantation for refractory hematologic malignancy. Int J Radiat Oncol Biol Phys 2002; 53: 151–156.

    Article  PubMed  Google Scholar 

  10. Blaise D, Maraninchi D, Archimbaud E, Reiffers J, Devergie A, Jouet JP et al. Allogeneic bone marrow transplantation for acute myeloid leukemia in first remission: a randomized trial of a busulfan-cytoxan versus cytoxan-total body irradiation as preparative regimen: a report from the Group d'Etudes de la Greffe de Moelle Osseuse. Blood 1992; 79: 2578–2582.

    CAS  PubMed  Google Scholar 

  11. Dusenbery KE, Steinbuch M, McGlave PB, Ramsay NK, Blazar BR, Neglia JP et al. Autologous bone marrow transplantation in acute myeloid leukemia: the University of Minnesota experience. Int J Radiat Oncol Biol Phys 1996; 36: 335–343.

    Article  CAS  PubMed  Google Scholar 

  12. Ringden O, Ruutu T, Remberger M, Nikoskelainen J, Volin L, Vindelov L et al. A randomized trial comparing busulfan with total body irradiation as conditioning in allogeneic marrow transplant recipients with leukemia: a report from the Nordic Bone Marrow Transplantation Group. Blood 1994; 83: 2723–2730.

    CAS  PubMed  Google Scholar 

  13. Boutard P, Reman O, Lemerle S, Guihard J . A relapse in the eye of acute lymphoblastic leukemia. Ann Pediatr (Paris) 1989; 36: 267–268.

    CAS  Google Scholar 

  14. Inoue T, Ikeda H, Yamazaki H, Tang JT, Song C, Teshima T et al. Role of total body irradiation as based on the comparison of preparation regimens for allogeneic bone marrow transplantation for acute leukemia in first complete remission. Strahlenther Onkol 1993; 169: 250–255.

    CAS  PubMed  Google Scholar 

  15. Shank B . The balancing act: pneumonitis vs relapse in cytoreductive regimens containing total body irradiation. Int J Radiat Oncol Biol Phys 1996; 36: 261–262.

    Article  CAS  PubMed  Google Scholar 

  16. Soubani AO, Miller KB, Hassoun PM . Pulmonary complications of bone marrow transplantation. Chest 1996; 109: 1066–1077.

    Article  CAS  PubMed  Google Scholar 

  17. Molls M, Budach V, Bamberg M . Total body irradiation: the lung as critical organ. Strahlenther Onkol 1986; 162: 226–232.

    CAS  PubMed  Google Scholar 

  18. Cardozo BL, Zoetelief H, van Bekkum DW, Zurcher C, Hagenbeek A . Lung damage following bone marrow transplantation: I. The contribution of irradiation. Int J Radiat Oncol Biol Phys 1985; 11: 907–914.

    Article  CAS  PubMed  Google Scholar 

  19. Thomas O, Mahe M, Campion L, Bourdin S, Milpied N, Brunet G et al. Long-term complications of total body irradiation in adults. Int J Radiat Oncol Biol Phys 2001; 49: 125–131.

    Article  PubMed  Google Scholar 

  20. Malicki J, Skrobala A, Kosicka G, Wachowiak J . The efficacy and reliability of lung protection during total body irradiation of patients with disseminated malignancies. Neoplasma 2005; 52: 325–329.

    CAS  PubMed  Google Scholar 

  21. Hirabayashi N, Goto S, Ishii M, Yuge M, Mitsuma A, Noda N . Busulfan, cyclophosphamide and total body irradiation as conditioning for allogeneic bone marrow transplantation for acute and chronic myeloid leukemia. Bone Marrow Transplant 1998; 21: 1079–1083.

    Article  CAS  PubMed  Google Scholar 

  22. Beyzadeoglu M, Oysul K, Dirican B, Arpaci F, Balkan A, Surenkok S et al. Effect of dose-rate and lung dose in total body irradiation on interstitial pneumonitis after bone marrow transplantation. Tohoku J Exp Med 2004; 202: 255–263.

    Article  PubMed  Google Scholar 

  23. Theuws JC, Kwa SL, Wagenaar AC, Seppenwoolde Y, Boersma LJ, Damen EM et al. Prediction of overall pulmonary function loss in relation to the 3-D dose distribution for patients with breast cancer and malignant lymphoma. Radiother Oncol 1998; 49: 233–243.

    Article  CAS  PubMed  Google Scholar 

  24. Della Volpe A, Ferreri AJ, Annaloro C, Mangili P, Rosso A, Calandrino R et al. Lethal pulmonary complications significantly correlate with individually assessed mean lung dose in patients with hematologic malignancies treated with total body irradiation. Int J Radiat Oncol Biol Phys 2002; 52: 483–488.

    Article  PubMed  Google Scholar 

  25. Theuws JC, Kwa SL, Wagenaar AC, Boersma LJ, Damen EM, Muller SH et al. Dose–effect relations for early local pulmonary injury after irradiation for malignant lymphoma and breast cancer. Radiother Oncol 1998; 48: 33–43.

    Article  CAS  PubMed  Google Scholar 

  26. Lohr F, Wenz F, Schraube P, Flentje M, Haas R, Zierhut D et al. Lethal pulmonary toxicity after autologous bone marrow transplantation/peripheral blood stem cell transplantation for hematological malignancies. Radiother Oncol 1998; 48: 45–51.

    Article  CAS  PubMed  Google Scholar 

  27. Gopal R, Ha CS, Tucker SL, Khouri IF, Giralt SA, Gajewski JL et al. Comparison of two total body irradiation fractionation regimens with respect to acute and late pulmonary toxicity. Cancer 2001; 92: 1949–1958.

    Article  CAS  PubMed  Google Scholar 

  28. Labar B, Bogdanic V, Nemet D, Mrsic M, Vrtar M, Grgic-Markulin L et al. Total body irradiation with or without lung shielding for allogeneic bone marrow transplantation. Bone Marrow Transplant 1992; 9: 343–347.

    CAS  PubMed  Google Scholar 

  29. Vriesendorp HM, Chu H, Ochran TG, Besa PC, Champlin RE . Radiobiology of total body radiation. Bone Marrow Transplant 1994; 14 (Suppl 4): S4–S8.

    PubMed  Google Scholar 

  30. Tait RC, Burnett AK, Robertson AG, McNee S, Riyami BM, Carter R et al. Subclinical pulmonary function defects following autologous and allogeneic bone marrow transplantation: relationship to total body irradiation and graft-versus-host disease. Int J Radiat Oncol Biol Phys 1991; 20: 1219–1227.

    Article  CAS  PubMed  Google Scholar 

  31. Socie G, Devergie A, Girinsky T, Reiffers J, Vernant JP, Le Bourgeois JP et al. Influence of the fractionation of total body irradiation on complications and relapse rate for chronic myelogenous leukemia. The Groupe d'Etude des greffes de moelle osseuse (GEGMO). Int J Radiat Oncol Biol Phys 1991; 20: 397–404.

    Article  CAS  PubMed  Google Scholar 

  32. Bearman SI, Appelbaum FR, Buckner CD, Petersen FB, Fisher LD, Clift RA et al. Regimen-related toxicity in patients undergoing bone marrow transplantation. J Clin Oncol 1988; 6: 1562–1568.

    Article  CAS  PubMed  Google Scholar 

  33. Shank B, Chu FC, Dinsmore R, Kapoor N, Kirkpatrick D, Teitelbaum H et al. Hyperfractionated total body irradiation for bone marrow transplantation. Results in seventy leukemia patients with allogeneic transplants. Int J Radiat Oncol Biol Phys 1983; 9: 1607–1611.

    Article  CAS  PubMed  Google Scholar 

  34. Latini P, Aristei C, Aversa F, Checcaglini F, Maranzano E, Raymondi C et al. Lung damage following bone marrow transplantation after hyperfractionated total body irradiation. Radiother Oncol 1991; 22: 127–132.

    Article  CAS  PubMed  Google Scholar 

  35. Singh AK, Karimpour SE, Savani BN, Guion P, Hope AJ, Mansueti JR et al. Pretransplant pulmonary function tests predict risk of mortality following fractionated total body irradiation and allogenic peripheral blood stem cell transplant. Int J Radiat Oncol Biol Phys 2006; 66: 520–527.

    Article  PubMed  Google Scholar 

  36. Crawford SW, Fisher L . Predictive value of pulmonary function tests before marrow transplantation. Chest 1992; 101: 1257–1264.

    Article  CAS  PubMed  Google Scholar 

  37. Carlson K, Backlund L, Smedmyr B, Oberg G, Simonsson B . Pulmonary function and complications subsequent to autologous bone marrow transplantation. Bone Marrow Transplant 1994; 14: 805–811.

    CAS  PubMed  Google Scholar 

  38. Chien JW, Maris MB, Sandmaier BM, Maloney DG, Storb RF, Clark JG . Comparison of lung function after myeloablative and 2 Gy of total body irradiation-based regimens for hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2005; 11: 288–296.

    Article  PubMed  Google Scholar 

  39. Solomon SR, Nakamura R, Read EJ, Leitman SF, Carter C, Childs R et al. Cyclosporine is required to prevent severe acute GVHD following T-cell-depleted peripheral blood stem cell transplantation. Bone Marrow Transplant 2003; 31: 783–788.

    Article  CAS  PubMed  Google Scholar 

  40. Nakamura R, Battiwalla M, Solomon S, Follmann D, Chakrabarti S, Cortez K et al. Persisting posttransplantation cytomegalovirus antigenemia correlates with poor lymphocyte proliferation to cytomegalovirus antigen and predicts for increased late relapse and treatment failure. Biol Blood Marrow Transplant 2004; 10: 49–57.

    Article  PubMed  Google Scholar 

  41. Cotes J . Lung Function, Assessment and Application in Medicine, 5th edn. Blackwell Scientific Publications: Cambridge, MA, 1993.

    Google Scholar 

  42. Weshler Z, Breuer R, Or R, Naparstek E, Pfeffer MR, Lowental E et al. Interstitial pneumonitis after total body irradiation: effect of partial lung shielding. Br J Haematol 1990; 74: 61–64.

    Article  CAS  PubMed  Google Scholar 

  43. Ellis ER, Marcus Jr RB, Cicale MJ, Springfield DS, Bova FJ, Graham-Pole J et al. Pulmonary function tests after whole-lung irradiation and doxorubicin in patients with osteogenic sarcoma. J Clin Oncol 1992; 10: 459–463.

    Article  CAS  PubMed  Google Scholar 

  44. Gore EM, Lawton CA, Ash RC, Lipchik RJ . Pulmonary function changes in long-term survivors of bone marrow transplantation. Int J Radiat Oncol Biol Phys 1996; 36: 67–75.

    Article  CAS  PubMed  Google Scholar 

  45. Savani BN, Montero A, Srinivasan R, Singh A, Shenoy A, Mielke S et al. Chronic GVHD and pre-transplant abnormalities in pulmonary function are the main determinants predicting worsening pulmonary function in long term survivors after stem cell transplantation. Biol Blood Marrow Transplant 2006; 12: 1261–1269.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This research was supported by the Intramural Research Program of the NIH, National Cancer Institute, Center for Cancer Research.

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Authors and Affiliations

  1. Radiation Biology Branch, National Cancer Institute, NIH, Bethesda, MD, USA

    B P Soule

  2. Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA

    N L Simone, H Ning & A K Singh

  3. National Heart Lung Blood Institute, NIH, Bethesda, MD, USA

    B N Savani & A J Barrett

  4. Biometric Research Branch, National Cancer Institute, NIH, Bethesda, MD, USA

    P S Albert

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Correspondence to A K Singh.

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Soule, B., Simone, N., Savani, B. et al. Pulmonary function following total body irradiation (with or without lung shielding) and allogeneic peripheral blood stem cell transplant. Bone Marrow Transplant 40, 573–578 (2007). https://doi.org/10.1038/sj.bmt.1705771

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