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Pneumonitis

Radiation-associated pneumonitis following autologous stem cell transplantation: predictive factors, disease characteristics and treatment outcomes

Bone Marrow Transplantation volume 27, pages 177–182 (2001)Cite this article

Abstract

High-dose therapy followed by autologous stem cell transplantation (ASCT) prolongs survival in patients with multiple myeloma and is relatively safe with treatment-related mortality rates of only 1–5%. Interstitial pneumonitis (IP) is normally an infrequent complication of ASCT with a reported incidence of 0–16%. Between 1992 and 1998, 94 myeloma patients at our center underwent ASCT using a high-dose regimen of etoposide (60 mg/kg), melphalan (160 mg/m2) and fractionated TBI 12 Gy. An unusually high incidence of IP (29/94 (31%)) was noted. Mortality in the IP patients was high at 45%. Patients developing IP were more frequently anemic than those who did not have pulmonary complications (hemoglobin <100 g/l) prior to transplant (P = 0.03) but no other pre-transplant factors were predictive (ie age, gender, smoking history, CMV status, pulmonary function, creatinine, β2-microglobulin or C-reactive protein, prior cumulative chemotherapy or chest irradiation). A significantly lower IP rate was noted in 32 contemporaneous myeloma control patients conditioned with BU-CY without TBI at our center (3/32 (9%); P = 0.03) and in 32 lymphoma control patients conditioned with the same melphalan and etoposide regimen minus the TBI (2/32 (6%); P = 0.003). In contrast, when using the same TBI-containing regimen in 32 concurrently treated lymphoma patients, an increase in IP similar to that seen in our myeloma cohort (7/32 (22%); P = 0.3) was noted. This strongly suggests that TBI is the predominant factor contributing to lung toxicity. We conclude that radiation-associated pneumonitis cannot be easily predicted by pre-transplant variables. Therefore surveillance, early recognition and prompt therapy are recommended. Bone Marrow Transplantation (2001) 27, 177–182.

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  1. University of Toronto Autologous Bone Marrow Transplant Program, The Princess Margaret Hospital, Toronto, Ontario, Canada

    CI Chen, R Abraham, R Tsang, M Crump, A Keating & AK Stewart

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  2. R Abraham
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Chen, C., Abraham, R., Tsang, R. et al. Radiation-associated pneumonitis following autologous stem cell transplantation: predictive factors, disease characteristics and treatment outcomes. Bone Marrow Transplant 27, 177–182 (2001). https://doi.org/10.1038/sj.bmt.1702771

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