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Severe pulmonary toxicity after myeloablative conditioning using total body irradiation: an assessment of risk factors.

Publication ,  Journal Article
Kelsey, CR; Horwitz, ME; Chino, JP; Craciunescu, O; Steffey, B; Folz, RJ; Chao, NJ; Rizzieri, DA; Marks, LB
Published in: Int J Radiat Oncol Biol Phys
November 1, 2011

PURPOSE: To assess factors associated with severe pulmonary toxicity after myeloablative conditioning using total body irradiation (TBI) followed by allogeneic stem cell transplantation. METHODS AND MATERIALS: A total of 101 adult patients who underwent TBI-based myeloablative conditioning for hematologic malignancies at Duke University between 1998 and 2008 were reviewed. TBI was combined with high-dose cyclophosphamide, melphalan, fludarabine, or etoposide, depending on the underlying disease. Acute pulmonary toxicity, occurring within 90 days of transplantation, was scored using Common Terminology Criteria for Adverse Events version 3.0. Actuarial overall survival and the cumulative incidence of acute pulmonary toxicity were calculated via the Kaplan-Meier method and compared using a log-rank test. A binary logistic regression analysis was performed to assess factors independently associated with acute severe pulmonary toxicity. RESULTS: The 90-day actuarial risk of developing severe (Grade 3-5) pulmonary toxicity was 33%. Actuarial survival at 90 days was 49% in patients with severe pulmonary toxicity vs. 94% in patients without (p < 0.001). On multivariate analysis, the number of prior chemotherapy regimens was the only factor independently associated with development of severe pulmonary toxicity (odds ratio, 2.7 per regimen). CONCLUSIONS: Severe acute pulmonary toxicity is prevalent after TBI-based myeloablative conditioning regimens, occurring in approximately 33% of patients. The number of prior chemotherapy regimens appears to be an important risk factor.

Duke Scholars

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

November 1, 2011

Volume

81

Issue

3

Start / End Page

812 / 818

Location

United States

Related Subject Headings

  • Young Adult
  • Whole-Body Irradiation
  • Vidarabine
  • Transplantation Conditioning
  • Stem Cell Transplantation
  • Risk Factors
  • Retrospective Studies
  • Pneumonia
  • Oncology & Carcinogenesis
  • Middle Aged
 

Citation

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Kelsey, C. R., Horwitz, M. E., Chino, J. P., Craciunescu, O., Steffey, B., Folz, R. J., … Marks, L. B. (2011). Severe pulmonary toxicity after myeloablative conditioning using total body irradiation: an assessment of risk factors. Int J Radiat Oncol Biol Phys, 81(3), 812–818. https://doi.org/10.1016/j.ijrobp.2010.06.058
Kelsey, Chris R., Mitchell E. Horwitz, Junzo P. Chino, Oana Craciunescu, Beverly Steffey, Rodney J. Folz, Nelson J. Chao, David A. Rizzieri, and Lawrence B. Marks. “Severe pulmonary toxicity after myeloablative conditioning using total body irradiation: an assessment of risk factors.Int J Radiat Oncol Biol Phys 81, no. 3 (November 1, 2011): 812–18. https://doi.org/10.1016/j.ijrobp.2010.06.058.
Kelsey CR, Horwitz ME, Chino JP, Craciunescu O, Steffey B, Folz RJ, et al. Severe pulmonary toxicity after myeloablative conditioning using total body irradiation: an assessment of risk factors. Int J Radiat Oncol Biol Phys. 2011 Nov 1;81(3):812–8.
Kelsey, Chris R., et al. “Severe pulmonary toxicity after myeloablative conditioning using total body irradiation: an assessment of risk factors.Int J Radiat Oncol Biol Phys, vol. 81, no. 3, Nov. 2011, pp. 812–18. Pubmed, doi:10.1016/j.ijrobp.2010.06.058.
Kelsey CR, Horwitz ME, Chino JP, Craciunescu O, Steffey B, Folz RJ, Chao NJ, Rizzieri DA, Marks LB. Severe pulmonary toxicity after myeloablative conditioning using total body irradiation: an assessment of risk factors. Int J Radiat Oncol Biol Phys. 2011 Nov 1;81(3):812–818.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

November 1, 2011

Volume

81

Issue

3

Start / End Page

812 / 818

Location

United States

Related Subject Headings

  • Young Adult
  • Whole-Body Irradiation
  • Vidarabine
  • Transplantation Conditioning
  • Stem Cell Transplantation
  • Risk Factors
  • Retrospective Studies
  • Pneumonia
  • Oncology & Carcinogenesis
  • Middle Aged