Pulmonary function following total body irradiation (with or without lung shielding) and allogeneic peripheral blood stem cell transplant

Abstract

Our purpose was to determine if total body irradiation (TBI) with lung dose reduction protects against subsequent radiation-induced deterioration in pulmonary function. Between July 1997 and August 2004, 181 consecutive patients with hematologic malignancies received fractionated TBI before allogeneic peripheral blood stem cell transplant. The first 89 patients were treated to a total dose of 13.6 Gy. Thereafter, total body dose was decreased to 12 Gy with lung dose reduction to 9 or 6 Gy. All patients underwent pulmonary function test evaluation before treatment, 90 days post-treatment, then annually. Median follow-up was 24.0 months. Eighty-nine patients were treated with lung shielding, and 92 without. At 1-year post transplant, there was a small but significant difference in lung volume measurements between patients with lung shielding and those without. This was not observed at the 2-year time point. When stratified by good (4100% predicted) or poor (p100% predicted) baseline lung function, patients with poor function demonstrated protection at 1 year with lung shielding, while those with good initial lung function did not. TBI with or without lung dose reduction has a small but statistically significant effect on pulmonary function measured at 1 year but not 2 years post irradiation.

Myeloablative conditioning with total body irradiation for AML: Balancing survival and pulmonary toxicity

“…The predefined primary outcome of interest was leukemia-free survival, defined as date of transplant to date of relapse or death from any cause, with patients censored at date of last follow-up. Secondary endpoints included overall survival, nonrelapse mortality, and the risk of pulmonary toxicity 20, 21. Overall survival was defined as date of transplant to death from any cause, again with patients censored at last follow-up.…”

Characterization of the Radiation-Damaged Precursor Cells in Bone Marrow Based on Modeling of the Peripheral Blood Granulocytes Response

“…In order to use cellular concentration in blood as a reliable assessment for radiation accident management, it is necessary to determine a robust relationship between the peripheral blood cells and the damaged bone marrow compartmental structure (NCRP 2001). The availability of such a methodology will prove extremely useful also in military operations involving nuclear warfare (Anno et al 1996), radiation therapy protocols design (Soule et al 2007), and space radiation risk assessment (NCRP 2006).…”

Investigation on using high‐energy proton beam for total body irradiation (TBI)

“…The primary goal of TBI is to destroy the recipient's bone marrow and tumor cells, and to immunosuppress the patient sufficiently to avoid rejection of the donor bone marrow. In general, a uniform dose across the patient body is desired in TBI, though there are special situations in which lungs or other critical organs (e.g., kidney and bowel) should be partially shielded to lower the risk of radiation‐induced injury 1 , 2 …”