Interstitial pneumonitis following bone marrow transplantation after low dose rate total body irradiation

• Published in: International journal of radiation oncology, biology, physics Vol. 9; no. 7; pp. 1029 - 1033
• Main Authors: Barrett, Ann, Depledge, Michael H., Powles, Raymond L.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.1983; Elsevier
• Subjects: Acute Disease; Adolescent; Adult; Biological and medical sciences; Bone Marrow Transplantation; Child; Cytomegalovirus Infections - etiology; Female; Hematologic and hematopoietic diseases; Herpes Simplex - etiology; Humans; immune response; immunocompetence; Interstitial pneumonitis; Leukemia - therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Low dose rate; Male; Medical sciences; Middle Aged; Pneumocystis carinii; pneumonia; Pneumonia, Pneumocystis - etiology; Pulmonary Fibrosis - etiology; Radiotherapy Dosage; Retrospective Studies; Total body irradiation; Whole-Body Irradiation - adverse effects; England; Interstitial pneumonitis; Low dose rate; Total body irradiation; Human; Treatment; Mediastinum; Acute; Leukemia; Homograft; Bone marrow; Radiation injury; Complication; Malignant hemopathy; Radiotherapy
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/0360-3016(83)90393-0

Idiopathic and infective interstitial pneumonitis (IPn) is a common complication after bone marrow transplantation (BMT) in many centers and carries a high mortality. We report here a series of 107 patients with acute leukemia grafted at the Royal Marsden Hospital in which only 11 (10.3%) developed IPn and only 5 died (5%). Only one case of idiopathic IPn was seen. Factors which may account for this low incidence are discussed. Sixty of 107 patients were transplanted in first remission of acute myeloid leukemia (AML) and were therefore in good general condition. Lung radiation doses were carefully monitored and doses of 10.5 Gy were not exceeded except in a group of 16 patients in whom a study of escalating doses of TBI (up to 13 Gy) was undertaken. The dose rate used for total body irradiation (TBI) was lower than that used in other centers and as demonstrated elsewhere by ourselves and others, reduction of dose rate to <0.05 Gy/min may be expected to lead to substantial reduction in lung damage. Threshold doses of approximately 8 Gy for IPn have been reported, but within the dose range of 8 to 10.5 Gy we suggest that dose rate may significantly affect the incidence. Data so far available suggest a true improvement in therapeutic ratio for low dose rate single fraction TBI compared with high dose rate.