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Total body irradiation followed by bone marrow transplantation: comparison of once-daily and twice-daily fractionation regimens

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Abstract

Purpose

The purpose of this study was to evaluate the results of two sequential total body irradiation (TBI) regimens, especially focusing on pulmonary complications.

Materials and methods

Patients with malignant disease who underwent TBI followed by bone marrow transplantation were retrospectively reviewed. There were 86 patients (51 males, 35 females). Altogether, 36 patients were treated on twice-daily fractions of 2 Gy for 3 days to a total 12 Gy (group A). Another 50 patients were treated on once-daily fractions of 2.4 or 3.0 Gy for 4 or 5 days to a total 12 Gy (group B).

Results

The 5-year overall survival rate was 49.2%, and relapse-free survival was 44.3%. There were no significant differences between the two groups regarding overall survival (P = 0.1237) or relapse-free survival (P = 0.1548). Two patients in group A had interstitial pneumonitis of grade 3 or higher severity compared with three patients in group B. There was no significant difference between patients in group A (5-year probability rate was 7.6%) and patients in group B (5-year probability rate was 13.9%) (P = 0.9519).

Conclusion

We concluded that our once-daily TBI regimen is feasible and had the benefit of reducing the complexity of TBI. We believe that further investigation of the TBI regimen is needed.

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References

  1. B Shank (1995) ArticleTitleCan total body irradiation be supplanted by busulfan and cytoreductive regimens for bone marrow transplantation? Int J Radiat Oncol Biol Phys 31 195–6 Occurrence Handle7995753 Occurrence Handle10.1016/0360-3016(94)00556-Z Occurrence Handle1:STN:280:ByqD1cfhsFU%3D

    Article  PubMed  CAS  Google Scholar 

  2. KE Dusenbery KA Daniels JS McClure PB McGlave NK Ramsay BR Blazar (1995) ArticleTitleRandomised comparison of cyclophosphamide-total body irradiation vs. busulfan-cyclophosphamide conditioning in autologous bone marrow transplantation for acute myeloid leukaemia Int J Radiat Oncol Biol Phys 31 119–28 Occurrence Handle7995742 Occurrence Handle10.1016/0360-3016(94)00335-I Occurrence Handle1:STN:280:ByqD1cfhtlw%3D

    Article  PubMed  CAS  Google Scholar 

  3. D Blaise D Maraninchi E Archimbaud J Reiffers A Devergie JP Jouet et al. (1992) ArticleTitleAllogeneic bone marrow transplantation for acute myeloid leukaemia in first remission: a randomized trial of a busulfan-Cytoxan versus Cytoxan-total body irradiation as preparative regimen: a report from the Group d'Etudes de la Greffe de Osseuse Blood 79 2578–82 Occurrence Handle1586710 Occurrence Handle1:STN:280:By2B28rptV0%3D

    PubMed  CAS  Google Scholar 

  4. O Ringden T Ruutu M Remberger J Nikoskelainen L Volin L Vindelov et al. (1994) ArticleTitleA randomized trial comparing busulfan with total body irradiation as conditioning in allogeneic marrow transplant recipients with leukaemia: a report from the Nordic Bone Marrow transplant Group Blood 83 2723–30 Occurrence Handle8167351 Occurrence Handle1:STN:280:ByuB38%2Fnt1Q%3D

    PubMed  CAS  Google Scholar 

  5. M Zecca A Pession C Messina F Bonetti C Favre A Prete et al. (1999) ArticleTitleTotal body irradiation, thiotepa and cyclophosphamide as a condition regimen with children for acute lymphoblastic leukaemia in first or second remission undergoing bone marrow transplantation with HLA-identical siblings J Clin Oncol 17 1838–46 Occurrence Handle10561223 Occurrence Handle1:CAS:528:DyaK1MXktV2qtb0%3D

    PubMed  CAS  Google Scholar 

  6. JC Lindegaard B Nielsen AM Boesen (1998) ArticleTitleTotal body irradiation improves the survival of patients with lymphoblastic lymphoma or Burkitt's lymphoma in first complete remission? Radiother Oncol 48S 18

    Google Scholar 

  7. KG Blume KJ Kopecky JP Henslee-Downey SJ Forman PJ Stiff CF LeMaistre et al. (1993) ArticleTitleA prospective randomized trial of total body irradiation-etoposide versus busulfan cyclophosphamide as preparatory regimens for bone marrow transplantation in patients with leukaemia who are not in first remission Blood 81 2187–93 Occurrence Handle8471778 Occurrence Handle1:STN:280:ByyB38bns1Y%3D

    PubMed  CAS  Google Scholar 

  8. O Ringden M Remberger T Ruutu J Nikoskelainen L Volin L Vindelov et al. (1999) ArticleTitleIncreased risk of chronic graft-versus-host disease, obstructive bronchiolitis, and alopecia with busulfan versus total body irradiation: long-term results of a randomized trial in allogeneic marrow recipients with leukemia; Nordic Bone Marrow Transplantation Group Blood 93 2196–201 Occurrence Handle10090927 Occurrence Handle1:CAS:528:DyaK1MXit1KhsLc%3D

    PubMed  CAS  Google Scholar 

  9. HM Vriesendorp H Chu TG Ochran PC Besa RE Champlin (1994) ArticleTitleRadiobiology of total body radiation Bone Marrow Transplant 14 S4–8 Occurrence Handle7728124

    PubMed  Google Scholar 

  10. RC Tait AK Burnett AG Robertson S McNee BM Riyami R Carter et al. (1991) ArticleTitleSubclinical pulmonary function defects following autologous and allogeneic bone marrow transplantation: relationship to total body irradiation and graft-versus-host disease Int J Radiat Oncol Biol Phys 20 1219–27 Occurrence Handle2045296 Occurrence Handle1:STN:280:By6B2Mfhs1Y%3D

    PubMed  CAS  Google Scholar 

  11. G Socie A Devergie T Girinsky J Reiffers JP Vernant JP Le Bourgeois et al. (1991) ArticleTitleInfluence of the fractionation of total body irradiation on complications and relapse rate for chronic myelogenous leukemia; the Groupe d'Etude des greffes de moelle osseuse (GEGMO) Int J Radiat Oncol Biol Phys 20 397–404 Occurrence Handle1995523 Occurrence Handle1:STN:280:By6C3sbktFU%3D

    PubMed  CAS  Google Scholar 

  12. F Lohr F Wenz P Schraube M Flentje R Haas D Zierhut et al. (1998) ArticleTitleLethal pulmonary toxicity after autologous bone marrow transplantation/peripheral blood stem cell transplantation for hematological malignancies Radiother Oncol 48 45–51 Occurrence Handle9756171 Occurrence Handle10.1016/S0167-8140(98)00045-0 Occurrence Handle1:STN:280:DyaK1cvislKjsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  13. RA Clift CD Buckner FR Appelbaum SI Bearman FB Petersen LD Fisher et al. (1990) ArticleTitleAllogeneic marrow transplantation in patients with acute myeloid leukemia in first remission: a randomized trial of two irradiation regimens Blood 76 1867–71 Occurrence Handle2224134 Occurrence Handle1:STN:280:By6D38fisFY%3D

    PubMed  CAS  Google Scholar 

  14. EC Kaplan P Meyer (1958) ArticleTitleNon parametric estimation from incomplete observations J Am Stat Assoc 53 457–81 Occurrence Handle10.2307/2281868

    Article  Google Scholar 

  15. JD Cox J Stetz TF Pajak (1995) ArticleTitleToxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) Int J Radiat Oncol Biol Phys 31 1341–6 Occurrence Handle7713792 Occurrence Handle10.1016/0360-3016(95)00060-C Occurrence Handle1:STN:280:ByqB38bkvVY%3D

    Article  PubMed  CAS  Google Scholar 

  16. FR Appelbaum (1993) ArticleTitleThe influence of total dose, fractionation, dose rate, and distribution of total body irradiation on bone marrow transplantation Semin Oncol 20 3–10 Occurrence Handle8342073 Occurrence Handle1:STN:280:ByyA2c3ls1U%3D

    PubMed  CAS  Google Scholar 

  17. AD Volpe AJM Ferreri C Annaloro P Mangili A Rosso R Calandrino et al. (2002) ArticleTitleLethal pulmonary complications significantly correlate with individually assessed mean lung dose in patients with hematologic malignancies treated with total body irradiation Int J Radiat Oncol Biol Phys 52 IssueID2 483–8 Occurrence Handle11872296 Occurrence Handle10.1016/S0360-3016(01)02589-5

    Article  PubMed  Google Scholar 

  18. S Sampath TE Schultheiss J Wong (2005) ArticleTitleDose response and factors related to interstitial pneumonitis after bone marrow transplant Int J Radiat Oncol Biol Phys 63 IssueID3 876–84 Occurrence Handle16199317 Occurrence Handle10.1016/j.ijrobp.2005.02.032

    Article  PubMed  Google Scholar 

  19. O Thomas M Mahe L Campion S Bourdin N Milpied G Brunet et al. (2001) ArticleTitleLong-term complications of total body irradiation in adults Int J Radiat Oncol Biol Phys 49 IssueID1 125–31 Occurrence Handle11163505 Occurrence Handle10.1016/S0360-3016(00)01373-0

    Article  PubMed  Google Scholar 

  20. M Ozsahin Y Belkacemi F Pene J Laporte B Rio V Leblond et al. (1996) ArticleTitleInterstitial pneumonitis following autologous bone-marrow transplantation conditioned with cyclophosphamide and total-body irradiation Int J Radiat Oncol Biol Phys 34 IssueID1 71–7 Occurrence Handle12118567 Occurrence Handle10.1016/0360-3016(95)02063-2 Occurrence Handle1:STN:280:DC%2BD38zntlGltA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  21. P Latini C Aristei F Aversa F Checcaglini E Maranzano C Raymondi et al. (1991) ArticleTitleLung damage following bone marrow transplantation after hyperfractionated total body irradiation Radiother Oncol 22 IssueID2 127–32 Occurrence Handle1957002 Occurrence Handle10.1016/0167-8140(91)90008-5 Occurrence Handle1:STN:280:By2D28nnsFI%3D

    Article  PubMed  CAS  Google Scholar 

  22. G Socie N Salooja A Cohen A Rovelli E Carreras A Locasciulli et al. (2003) ArticleTitleLate Effects Working Party of the European Study Group for Blood and Marrow Transplantation: nonmalignant late effects after allogeneic stem cell transplantation Blood 101 IssueID9 3373–85 Occurrence Handle12511420 Occurrence Handle10.1182/blood-2002-07-2231 Occurrence Handle1:CAS:528:DC%2BD3sXjs1aqs70%3D

    Article  PubMed  CAS  Google Scholar 

  23. Y Hatta T Itoh M Baba T Izumi I Sasaki H Shimojima et al. (1998) ArticleTitlePulmonary function at the early stage after bone marrow transplantation Rinsho Ketsueki 39 IssueID9 645–51 Occurrence Handle9796397 Occurrence Handle1:STN:280:DyaK1M%2Fht1Cruw%3D%3D

    PubMed  CAS  Google Scholar 

  24. R Gopal CS Ha SL Tucker IF Khouri SA Giralt JL Gajewski et al. (2001) ArticleTitleComparison of two total body irradiation fractionation regimens with respect to acute and late pulmonary toxicity Cancer 92 1949–58 Occurrence Handle11745270 Occurrence Handle10.1002/1097-0142(20011001)92:7<1949::AID-CNCR1714>3.0.CO;2-1 Occurrence Handle1:STN:280:DC%2BD3MnpsFKrtQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Toshinori Soejima.

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Soejima, T., Hirota, S., Tsujino, K. et al. Total body irradiation followed by bone marrow transplantation: comparison of once-daily and twice-daily fractionation regimens. Radiat Med 25, 402–406 (2007). https://doi.org/10.1007/s11604-007-0157-z

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  • DOI: https://doi.org/10.1007/s11604-007-0157-z

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