Radiation-associated pneumonitis following autologous stem cell transplantation: Predictive factors, disease characteristics and treatment outcomes

C. I. Chen, R. Abraham, R. Tsang, M. Crump, A. Keating, Alexander Keith Stewart

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

High-dose therapy followed by autologous stem cell transplantation (ASCT) prolongs survival in patients with multiple myeloma and is relatively safe with treatment-related mortality rates of only 1-5%. Interstitial pneumonitis (IP) is normally an infrequent complication of ASCT with a reported incidence of 0-16%. Between 1992 and 1998, 94 myeloma patients at our center underwent ASCT using a high-dose regimen of etoposide (60 mg/kg), melphalan (160 mg/m2) and fractionated TBI 12 Gy. An unusually high incidence of IP (29/94(31%)) was noted. Mortality in the IP patients was high at 45%. Patients developing IP were more frequently anemic than those who did not have pulmonary complications (hemoglobin <100g/l) prior to transplant (P = 0.03) but no other pre-transplant factors were predictive (ie age, gender, smoking history, CMV status, pulmonary function, creatinine, β2-microglobulin or C-reactive protein, prior cumulative chemotherapy or chest irradiation). A significantly lower IP rate was noted in 32 contemporaneous myeloma control patients conditioned with BU-CY without TBI at our center (3/32 (9%); P = 0.03) and in 32 lymphoma control patients conditioned with the same melphalan and etoposide regimen minus the TBI (2/32 (6%); P = 0.003). In contrast, when using the same TBI-containing regimen in 32 concurrently treated lymphoma patients, an increase in IP similar to that seen in our myeloma cohort (7/32 (22%); P = 0.3) was noted. This strongly suggests that TBI is the predominant factor contributing to lung toxicity. We conclude that radiation-associated pneumonitis cannot be easily predicted by pretransplant variables. Therefore surveillance, early recognition and prompt therapy are recommended.

Original languageEnglish (US)
Pages (from-to)177-182
Number of pages6
JournalBone Marrow Transplantation
Volume27
Issue number2
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

Radiation Pneumonitis
Stem Cell Transplantation
Interstitial Lung Diseases
Melphalan
Etoposide
Lung
Lymphoma
Transplants
Mortality
Incidence
Multiple Myeloma
C-Reactive Protein
Creatinine
Hemoglobins
Thorax
Therapeutics
Smoking
History
Drug Therapy
Survival

Keywords

  • Autotransplant
  • Myeloma
  • Pneumonitis
  • Pulmonary
  • Radiation
  • TBI

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Radiation-associated pneumonitis following autologous stem cell transplantation : Predictive factors, disease characteristics and treatment outcomes. / Chen, C. I.; Abraham, R.; Tsang, R.; Crump, M.; Keating, A.; Stewart, Alexander Keith.

In: Bone Marrow Transplantation, Vol. 27, No. 2, 2001, p. 177-182.

Research output: Contribution to journalArticle

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abstract = "High-dose therapy followed by autologous stem cell transplantation (ASCT) prolongs survival in patients with multiple myeloma and is relatively safe with treatment-related mortality rates of only 1-5{\%}. Interstitial pneumonitis (IP) is normally an infrequent complication of ASCT with a reported incidence of 0-16{\%}. Between 1992 and 1998, 94 myeloma patients at our center underwent ASCT using a high-dose regimen of etoposide (60 mg/kg), melphalan (160 mg/m2) and fractionated TBI 12 Gy. An unusually high incidence of IP (29/94(31{\%})) was noted. Mortality in the IP patients was high at 45{\%}. Patients developing IP were more frequently anemic than those who did not have pulmonary complications (hemoglobin <100g/l) prior to transplant (P = 0.03) but no other pre-transplant factors were predictive (ie age, gender, smoking history, CMV status, pulmonary function, creatinine, β2-microglobulin or C-reactive protein, prior cumulative chemotherapy or chest irradiation). A significantly lower IP rate was noted in 32 contemporaneous myeloma control patients conditioned with BU-CY without TBI at our center (3/32 (9{\%}); P = 0.03) and in 32 lymphoma control patients conditioned with the same melphalan and etoposide regimen minus the TBI (2/32 (6{\%}); P = 0.003). In contrast, when using the same TBI-containing regimen in 32 concurrently treated lymphoma patients, an increase in IP similar to that seen in our myeloma cohort (7/32 (22{\%}); P = 0.3) was noted. This strongly suggests that TBI is the predominant factor contributing to lung toxicity. We conclude that radiation-associated pneumonitis cannot be easily predicted by pretransplant variables. Therefore surveillance, early recognition and prompt therapy are recommended.",
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