Pulmonary complications of bone marrow transplantation: the impact of variations in total body irradiation parameters.
In this article we report and discuss the pulmonary complications in patients who received a single exposure total body irradiation (TBI) to a total dose of 7.5 Gy at a dose rate of 0.15 Gy/min, a TBI regimen which has the advantage of being given in a single, relatively short exposure, with an active treatment time of less than 1 hour. This forms a part of the bone marrow transplantation programme for the management of certain haematological malignancies at the Leicester Regional Centre. Between July 1986 and October 1990, we treated 31 patients with such a regimen. Full respiratory function tests (RFT) were carried out, prior to TBI, in the majority of patients. After a mean follow-up period of 34 months, 13 patients were alive; full RFT were repeated in all of them. Of the total of 31 patients, only one patient died, from late non-specific pneumonitis; in this case, high dose busulphan was added to conventional cyclophosphamide and TBI. Another patient died as a direct result of cytomegalovirus pneumonia. Comparison of pre- and post-TBI RFT showed no resultant obstructive, restrictive or transfer factor defects. In the three patients who did not have pre-TBI RFT, post-TBI RFT did not reveal any significant change from expected values for age, sex and height. Several major centres have reported their experience using various combinations of different total doses, dose rates and fractionations. Having compared our results with theirs, we conclude that, following this relatively short and convenient single exposure TBI, there is no evidence of increased acute or chronic pulmonary toxicity.
Leicestershire Centre for Clinical Oncology, Leicester Royal Infirmary, UK.
H A
HA
Kader
S
S
Khanna
R M
RM
Hutchinson
R J
RJ
Aukett
J
J
Archer
D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D006801:Humans; D007938:Leukemia / Q000628:therapy; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology*; D011014:Pneumonia / Q000209:etiology; D015656:Respiratory Mechanics; D014916:Whole-Body Irradiation / Q000009:adverse effects*