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Post-Transplant Complications

Eye shielding during total body irradiation for bone marrow transplantation in children transplanted for a hematological disorder: risks and benefits

Bone Marrow Transplantation volume 31, pages 1151–1156 (2003)Cite this article

Summary:

This is a retrospective analysis of 188 children who underwent total body irradiation (TBI) in one or two fractions before bone marrow transplantation (BMT) for a hematological disorder. While 139 children had eye shielding during TBI to decrease cataract formation, 49 did not. The blocks used for shielding caused cylindrical areas of decreased dose intensity in the brain. The aim of the study was to determine if there was an increased risk of relapse in the eyes or in the CNS after shielding of the eyes. The probability and severity of cataract formation with and without shielding were also evaluated. None of the 49 children without shielding had a relapse in their eyes or in the CNS after BMT. Of the children with shielding, none had a relapse in the eyes but two of the 139 (1.4%) had a CNS relapse. The incidence of cataracts without shielding was 90% (19 of 21 evaluable patients), while with shielding it was 31% (20 of 64). Severe cataracts were present in eight of 21 (38%) patients without and two of 64 (3%) patients with shielding. The probability of staying cataract free for at least five years was 0.77 with and 0.33 without shielding, at 8 years it was 0.53 and 0.24 respectively. The relative risk of developing a cataract without shielding vs shielding was three (95% CI=1.5; 5.9). It appears that the incidence of relapse in the eyes and CNS is not increased when the eyes are shielded during TBI. Shielding increased the latency time of cataract formation and decreased the severity of cataracts.

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Authors and Affiliations

  1. Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands

    M L van Kempen-Harteveld, H Struikmans & H B Kal

  2. Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands

    M H van Weel-Sipman & J M J J Vossen

  3. Faculty of Medicine, Leiden, The Netherlands

    C Emmens

  4. Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands

    E M Noordijk

  5. Center of Biostatistics, Utrecht University, Utrecht, The Netherlands

    I van der Tweel

  6. Department of Pediatric Hematology, University Medical Center Utrecht, Utrecht, The Netherlands

    T Révész

  7. Dutch Childhood Leukemia Study Group, The Hague, The Netherlands

    A van der Does-van den Berg

Authors
  1. M L van Kempen-Harteveld
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  2. M H van Weel-Sipman
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  3. C Emmens
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  4. E M Noordijk
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  8. H B Kal
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  9. A van der Does-van den Berg
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  10. J M J J Vossen
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van Kempen-Harteveld, M., van Weel-Sipman, M., Emmens, C. et al. Eye shielding during total body irradiation for bone marrow transplantation in children transplanted for a hematological disorder: risks and benefits. Bone Marrow Transplant 31, 1151–1156 (2003). https://doi.org/10.1038/sj.bmt.1704076

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