Lung damage following bone marrow transplantation after hyperfractionated total body irradiation

Latini, P; Aristei, Cynthia; Aversa, Franco; Checcaglini, F; Maranzano, Ernesto; Raymondi, C.; Panizza, Bianca Moira; Perrucci, Elisabetta; Martelli, Massimo F.

doi:10.1016/0167-8140(91)90008-5

Cited by 35 publications

(18 citation statements)

References 27 publications

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“…TBI was the first treatment administered to all patients, followed by the chemotherapy schemes described in past studies. [18][19][20][21][22][23][24] The rationale behind the use of the different pre-transplant schedules, selected according to the type of transplant, has been explained previously. [18][19][20][21]25 Ophthalmological examinations were carried out before transplant, 6 and 12 months after, and subsequently yearly.…”

Section: Methodsmentioning

confidence: 99%

Cataracts in patients receiving stem cell transplantation after conditioning with total body irradiation

Aristei

Alessandro

Santucci

et al. 2002

Bone Marrow Transplant

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Summary:One hundred and ninety-three patients with hematological malignancies and a follow-up у1 year, treated with stem cell transplantation (45 autologous, 99 allogeneic T cell-depleted matched, 49 allogeneic T cell-depleted mismatched) from July 1985 to May 1998, were considered evaluable for the development of cataracts. Total body irradiation (TBI), administered either according to a hyperfractionated scheme (HTBI) or in a single dose (STBI), was employed in the conditioning regimens. HTBI was prescribed in 94% of patients undergoing allogeneic matched transplant, while STBI was used in 71% of patients receiving allogeneic mismatched and in all patients undergoing autologous transplant. The median follow-up was 7.56 years in the HTBI and 3.02 years in the STBI group. Among the different risk factors analyzed by univariate analysis only the TBI scheme and type of transplant reached statistical significance (P Ͻ 0.0001 and P Ͻ 0.001, respectively). By multivariate analysis only the TBI scheme was an independent factor for cataract development (STBI vs HTBI RR 7.2; P Ͻ 0.01). Our results showed that STBI is more cataractogenic than HTBI. The incidence of cataract we observed was among the lowest described in the literature. T cell depletion, because it prevents graft-versus-host disease and reduces the protracted use of post-transplant steroids, explains the results we obtained. Bone Marrow Transplantation (2002) 29, 503-507. DOI: 10.1038/sj/bmt/1703400 Keywords: cataract; total body irradiation; stem cell transplantation Advances in transplant techniques over the past 20 years have improved long-term survival of patients receiving bone marrow transplant (BMT) and, consequently, have

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Section: Methodsmentioning

confidence: 99%

Cataracts in patients receiving stem cell transplantation after conditioning with total body irradiation

Aristei

Alessandro

Santucci

et al. 2002

Bone Marrow Transplant

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“…[15][16][17][18][19][20][21][22] Studies have shown that the severity depends on both dose rate and total dose administered. [22][23][24][25][26] Several strategies have emerged to address this complication, including increasing the fractionation schedule to decrease the radiation dose administered at any one time [26][27][28][29][30][31][32][33][34] and reducing the lung dose directly by utilizing lung shielding. 17,28 Several studies have described an association between lung dose reduction and pulmonary-related mortality and overall survival.…”

Section: Introductionmentioning

confidence: 99%

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

Soule

Simone

Savani

et al. 2007

Bone Marrow Transplant

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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 (4100% predicted) or poor (p100% 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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“…A number of parameters, such as lung dose, dose distribution in the lungs, dose rate, fractionation, and lung-toxic chemotherapeutic agents, may infl uence the rate of interstitial pneumonitis. [16][17][18][19][20][21][22][23] However, it is still diffi cult to assess the optimal TBI regimen for the various reported TBI techniques.…”

Section: Discussionmentioning

confidence: 99%

Total body irradiation followed by bone marrow transplantation: comparison of once-daily and twice-daily fractionation regimens

et al. 2007

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Lung damage following bone marrow transplantation after hyperfractionated total body irradiation

Cited by 35 publications

References 27 publications

Cataracts in patients receiving stem cell transplantation after conditioning with total body irradiation

Cataracts in patients receiving stem cell transplantation after conditioning with total body irradiation

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

Total body irradiation followed by bone marrow transplantation: comparison of once-daily and twice-daily fractionation regimens

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