title: Lethal pulmonary complications significantly correlate with individually assessed mean lung dose in patients with hematologic malignancies treated with total body irradiation.
abstract: OBJECTIVE
  To assess the impact of lung dose on lethal pulmonary complications (LPCs) in a single-center group of patients with hematologic malignancies treated with total body irradiation (TBI) in the conditioning regimen for bone marrow transplantation (BMT).
  
  
  METHODS
  The mean lung dose of 101 TBI-conditioned patients was assessed by a thorough (1 SD around 2%) in vivo transit dosimetry technique. Fractionated TBI (10 Gy, 3.33 Gy/fraction, 1 fraction/d, 0.055 Gy/min) was delivered using a lateral-opposed beam technique with shielding of the lung by the arms. The median lung dose was 9.4 Gy (1 SD 0.8 Gy, range 7.8--11.4). The LPCs included idiopathic interstitial pneumonia (IIP) and non-idiopathic IP (non-IIP).
  
  
  RESULTS
  Nine LPCs were observed. LPCs were observed in 2 (3.8%) of 52 patients in the group with a lung dose < or = 9.4 Gy and in 7 (14.3%) of 49 patients in the >9.4 Gy group. The 6-month LPC risk was 3.8% and 19.2% (p = 0.05), respectively. A multivariate analysis adjusted by the following variables: type of malignancy (acute leukemia, chronic leukemia, lymphoma, myeloma), type of BMT (allogeneic, autologous), cytomegalovirus infection, graft vs. host disease, and previously administered drugs (bleomycin, cytarabine, cyclophosphamide, nitrosoureas), revealed a significant and independent association between lung dose and LPC risk (p = 0.02; relative risk = 6.7). Of the variables analyzed, BMT type (p = 0.04; relative risk = 6.6) had a risk predictive role.
  
  
  CONCLUSIONS
  The mean lung dose is an independent predictor of LPC risk in patients treated with the 3 x 3.33-Gy low-dose-rate TBI technique. Allogeneic BMT is associated with a higher risk of LPCs.
authors.affiliation: Centro Trapianti di Midollo, Ospedale Maggiore di Milano IRCCS, Milano, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Della Volpe
authors.forename: Andrés José María
authors.initials: AJ
authors.lastname: Ferreri
authors.forename: Claudio
authors.initials: C
authors.lastname: Annaloro
authors.forename: Paola
authors.initials: P
authors.lastname: Mangili
authors.forename: Alberto
authors.initials: A
authors.lastname: Rosso
authors.forename: Riccardo
authors.initials: R
authors.lastname: Calandrino
authors.forename: Eugenio
authors.initials: E
authors.lastname: Villa
authors.forename: Giorgio
authors.initials: G
authors.lastname: Lambertenghi-Deliliers
authors.forename: Claudio
authors.initials: C
authors.lastname: Fiorino
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D016026:Bone Marrow Transplantation / Q000401:mortality; D002648:Child; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D006801:Humans; D007938:Leukemia / Q000401:mortality / Q000628:therapy*; D008171:Lung Diseases / Q000209:etiology* / Q000401:mortality; D008223:Lymphoma / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000150:complications*; D019172:Transplantation Conditioning; D014916:Whole-Body Irradiation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality