title: Long-term follow-up of pediatric patients receiving total body irradiation before hematopoietic stem cell transplantation and post-transplant survival of >2 years.
abstract: BACKGROUND
  Total body irradiation (TBI) treatment eradicates malignant cells and suppresses the immune system before hematopoietic stem cell transplantation (HSCT). The radiation dose is limited by its toxicity to healthy organs. Many reports describe long-term sequelae from TBI in adults, but comparable data for pediatric patients are scarce.
  
  
  METHODS
  We evaluated late effects of a cohort of survivors after at least 2 years from 106 children treated with TBI and HSCT between 1985 and 2008. Follow-up was available from 39 patients with a mean duration of 8.3 (range 2.0-21.9) years. We examined cardiac, pulmonary and renal function, longitudinal growth, weight development, endocrinological parameters, and gastrointestinal problems.
  
  
  RESULTS
  Initial remission status and overall survival were significantly correlated. None of the 39 patients experienced cardiac dysfunction or changes in pulmonal function, but 5 exhibited renal impairment. Gastrointestinal problems were reported by 4 patients, and 10 patients had severe growth impairment. Altogether, our follow-up of pediatric patients who survived TBI-containing conditioning regimens for more than 2 years showed no cardiac morbidity or pulmonary aggravation, but mild renal sequelae and growth impairment.
  
  
  CONCLUSIONS
  The adverse long-term effects of TBI in our cohort of children surviving at least 2 years after TBI and HSCT seem to be within a tolerable range. Future studies are required to investigate whether conditioning regimens lacking TBI result in a better ratio of benefits to overall side effects.
authors.affiliation: Department of Pediatric Hematology-Oncology, Pediatrics III, University Duisburg-Essen, Essen, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Künkele
authors.forename: Marianne
authors.initials: M
authors.lastname: Engelhard
authors.forename: Berthold P
authors.initials: BP
authors.lastname: Hauffa
authors.forename: Uwe
authors.initials: U
authors.lastname: Mellies
authors.forename: Carsten
authors.initials: C
authors.lastname: Müntjes
authors.forename: Claudia
authors.initials: C
authors.lastname: Hüer
authors.forename: Angelika
authors.initials: A
authors.lastname: Eggert
authors.forename: Johannes H
authors.initials: JH
authors.lastname: Schulte
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kremens
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D017741:Survivors / Q000706:statistics & numerical data*; D013995:Time; D014916:Whole-Body Irradiation / Q000009:adverse effects*; D055815:Young Adult
keywords: long-term sequelae; pediatric hematopoietic stem cell transplantation; total body irradiation