Reduced incidence of interstitial pneumonitis after allogeneic hematopoietic stem cell transplantation using a modified technique of total body irradiation.
Allogeneic hematopoietic stem cell transplantation is a curative-intent treatment for patients with high-risk hematologic diseases. However, interstitial pneumonitis (IP) and other toxicities remain major concerns after total body irradiation (TBI). We have proposed using linear accelerators with rice-bag compensators for intensity modulation (IM-TBI), as an alternative to the traditional cobalt-60 teletherapy with lung-shielding technique (Co-TBI). Patients who received a TBI-based myeloablative conditioning regimen between 1995 and 2014 were recruited consecutively. Before March 2007, TBI was delivered using Co-TBI (n = 181); afterward, TBI was administered using IM-TBI (n = 126). Forty-four patients developed IP; of these cases, 19 were idiopathic. The IP-related mortality rate was 50% in the total IP cohort and 63% in the idiopathic subgroup. The 1-year cumulative incidences of IP and idiopathic IP were 16.5% and 7.4%, respectively; both rates were significantly higher in the Co-TBI group than in the IM-TBI group. Multivariate analysis revealed that Co-TBI was an independent prognostic factor for both total and idiopathic IP. In the acute myeloid leukemia subgroup, patients with different TBI techniques had similar outcomes for both overall and relapse-free survival. In conclusion, IM-TBI is an easy and effective TBI technique that could substantially reduce the complication rate of IP without compromising treatment efficacy.
Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
Yun
Y
Chiang
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Tai-Cheng Stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan.|Genome and Systems Biology Degree Program, National Taiwan University, Taipei, Taiwan.
Cheng-Hong
CH
Tsai
Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
Sung-Hsin
SH
Kuo
Biostatistics Consulting Laboratory, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
Chieh-Yu
CY
Liu
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Ming
M
Yao
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Tai-Cheng Stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan.
Chi-Cheng
CC
Li
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Shang-Yi
SY
Huang
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Bor-Sheng
BS
Ko
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Tai-Cheng Stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan.
Chien-Ting
CT
Lin
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Hsin-An
HA
Hou
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Depart of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Wen-Chien
WC
Chou
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Tai-Cheng Stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan.
Jia-Hau
JH
Liu
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Depart of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Chien-Chin
CC
Lin
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Shang-Ju
SJ
Wu
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Depart of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Szu-Chun
SC
Hsu
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Depart of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Yao-Chang
YC
Chen
Division of Hematology/Oncology, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Kai-Hsin
KH
Lin
Depart of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Division of Hematology/Oncology, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Dong-Tsamn
DT
Lin
Division of Hematology/Oncology, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Hsien-Tang
HT
Chou
Division of Hematology/Oncology, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Meng-Yu
MY
Lu
Depart of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Division of Hematology/Oncology, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Yung-Li
YL
Yang
Division of Hematology/Oncology, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Hsiu-Hao
HH
Chang
Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan.
Ming-Chih
MC
Liu
Tai-Cheng Stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan.
Xiu-Wen
XW
Liao
Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.|Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan.
Jian-Kuen
JK
Wu
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Sheng-Chieh
SC
Chou
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Chieh-Lung
CL
Cheng
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Chien-Yuan
CY
Chen
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Woei
W
Tsay
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Hwei-Fang
HF
Tien
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Tai-Cheng Stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan.
Jih-Luh
JL
Tang
Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
Yu-Hsuan
YH
Chen
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000532:radiotherapy*; D017563:Lung Diseases, Interstitial / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014916:Whole-Body Irradiation; D055815:Young Adult