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

Authors
 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 
Citation
 Radiation Oncology Journal, Vol.35(3) : 257-267, 2017 
Journal Title
 Radiation Oncology Journal 
ISSN
 2234-1900 
Issue Date
2017
Keywords
Idiopathic pneumonia syndrome ; Infectious pneumonia ; Stem cell transplantation ; Total body irradiation
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.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/161078
DOI
10.3857/roj.2017.00290
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Pediatrics (소아청소년과학교실)
Yonsei Authors
김수정(Kim, Soo Jeong) ; 김진석(Kim, Jin Seok) ; 김현주(Kim, Hyun Ju) ; 민유홍(Min, Yoo Hong) ; 변화경(Byun, Hwa Kyung) ; 서창옥(Suh, Chang Ok) ; 유철주(Lyu, Chuhl Joo) ; 윤홍인(Yoon, Hong In) ; 이원희(Lee, Won Hee) ; 정준원(Cheong, June-Won) ; 조재호(Cho, Jae Ho)
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