Reduced incidence of interstitial pneumonitis after Allogeneic hematopoietic stem cell transplantation using a modified technique of total body irradiation
Journal
Scientific Reports
Journal Volume
6
Pages
36730
Date Issued
2016
Author(s)
Liu, Chieh-Yu
Li, Chi-Cheng
Lin, Chien-Ting
Lin, Kai-Hsin
Lin, Dong-Tsamn
Chou, Hsien-Tang
Lu, Meng-Yu
Liu, Ming-Chih
Liao, Xiu-Wen
Wu, Jian-Kuen
Abstract
Allogeneic hematopoietic stem cell transplantation is a curative-intent treatment for patients with high-risk hematologic diseases. However, interstitial pneumonitis (IP) and other toxicities remain major concerns after total body irradiation (TBI). We have proposed using linear accelerators with rice-bag compensators for intensity modulation (IM-TBI), as an alternative to the traditional cobalt-60 teletherapy with lung-shielding technique (Co-TBI). Patients who received a TBI-based myeloablative conditioning regimen between 1995 and 2014 were recruited consecutively. Before March 2007, TBI was delivered using Co-TBI (n = 181); afterward, TBI was administered using IM-TBI (n = 126). Forty-four patients developed IP; of these cases, 19 were idiopathic. The IP-related mortality rate was 50% in the total IP cohort and 63% in the idiopathic subgroup. The 1-year cumulative incidences of IP and idiopathic IP were 16.5% and 7.4%, respectively; both rates were significantly higher in the Co-TBI group than in the IM-TBI group. Multivariate analysis revealed that Co-TBI was an independent prognostic factor for both total and idiopathic IP. In the acute myeloid leukemia subgroup, patients with different TBI techniques had similar outcomes for both overall and relapse-free survival. In conclusion, IM-TBI is an easy and effective TBI technique that could substantially reduce the complication rate of IP without compromising treatment efficacy.
SDGs
Other Subjects
adolescent; adult; allotransplantation; child; disease free survival; female; hematopoietic stem cell transplantation; human; incidence; interstitial lung disease; leukemia; male; middle aged; preschool child; prognosis; proportional hazards model; radiation injury; retrospective study; risk factor; treatment outcome; whole body radiation; young adult; Adolescent; Adult; Child; Child, Preschool; Disease-Free Survival; Female; Hematopoietic Stem Cell Transplantation; Humans; Incidence; Leukemia; Lung Diseases, Interstitial; Male; Middle Aged; Prognosis; Proportional Hazards Models; Radiation Injuries; Retrospective Studies; Risk Factors; Transplantation, Homologous; Treatment Outcome; Whole-Body Irradiation; Young Adult
Publisher
Nature Publishing Group
Type
journal article