Pretransplant pulmonary function tests predict risk of mortality following fractionated total body irradiation and allogeneic peripheral blood stem cell transplant.
OBJECTIVE
To determine the value of pulmonary function tests (PFTs) done before peripheral blood stem cell transplant (PBSCT) in predicting mortality after total body irradiation (TBI) performed with or without dose reduction to the lung.


METHODS
From 1997 to 2004, 146 consecutive patients with hematologic malignancies received fractionated TBI before PBSCT. With regimen A (n=85), patients were treated without lung dose reduction to 13.6 gray (Gy). In regimen B (n=35), total body dose was decreased to 12 Gy (1.5 Gy twice per day for 4 days) and lung dose was limited to 9 Gy by use of lung shielding. In regimen C (n=26), lung dose was reduced to 6 Gy. All patients received PFTs before treatment, 90 days after treatment, and annually.


RESULTS
Median follow-up was 44 months (range, 12-90 months). Sixty-one patients had combined ventilation/diffusion capacity deficits defined as both a forced expiratory volume in the first second (FEV1) and a diffusion capacity of carbon dioxide (DLCO)<100% predicted. In this group, there was a 20% improvement in one-year overall survival with lung dose reduction (70 vs. 50%, log-rank test p=0.042).


CONCLUSIONS
Among those with combined ventilation/diffusion capacity deficits, lung dose reduction during TBI significantly improved survival.
Singh
Anurag K
AK
Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA. singan@mail.nih.gov
Karimpour
Shervin E
SE
Savani
Bipin N
BN
Guion
Peter
P
Hope
Andrew J
AJ
Mansueti
John R
JR
Ning
Holly
H
Altemus
Rosemary M
RM
Wu
Colin O
CO
Barrett
A John
AJ
D000328:Adult; D005260:Female; D005541:Forced Expiratory Volume; D019337:Hematologic Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D008168:Lung / Q000503:physiopathology / Q000528:radiation effects*; D008297:Male; D011653:Pulmonary Diffusing Capacity; D011835:Radiation Protection; D011879:Radiotherapy Dosage; D012129:Respiratory Function Tests; D019172:Transplantation Conditioning; D014916:Whole-Body Irradiation / Q000009:adverse effects* / Q000401:mortality