Dose response and factors related to interstitial pneumonitis after bone marrow transplant
Dose response and factors related to interstitial pneumonitis after bone marrow transplant
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DOI：
10.1016/j.ijrobp.2005.02.032
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发表时间：
2005-11-01
影响因子：
7
通讯作者：
Wong, J
中科院分区：
文献类型：
--
作者：
Sampath, S;Schultheiss, TE;Wong, J
目的：全身照射（TBI）和化疗是骨髓移植预处理方案的常见组成部分。间质性肺炎（IP）是一种已知的方案相关并发症。使用已发表的IP数据进行多变量logistic回归，本研究旨在确定骨髓移植预处理方案中与IP显著相关的参数，并建立辐射剂量-反应函数。方法和材料：对报告IP发生率沿着肺剂量、分次、剂量率和化疗方案的文章进行了回顾性审查。在最终分析中，20篇文章（n = 1090例患者），包括26种不同的TBI/化疗方案，被纳入分析。进行多变量逻辑回归以确定影响IP发生率的剂量学和化疗因素。结果：从接受每日放射分数的患者中生成逻辑模型。在该模型中，肺剂量、环磷酰胺剂量和白消安添加与IP显著相关。根据模型估计，仅化疗预处理方案的发生率为3%-4%。线性二次模型的α/β值估计为2.8戈伊。120 mg/kg环磷酰胺给药后IP的50%发生率D-50剂量为8.8戈伊;在未化疗的情况下，估计D-50为10.6戈伊。未观察到剂量率效应。使用白消安作为放射治疗的替代品相当于用14.8戈伊分4次治疗，50%的传输块屏蔽肺。逻辑回归未能找到一个模型，充分适合每天多个部分的数据。结论：确定了肺辐射剂量和环磷酰胺剂量的剂量反应。12戈伊TBI每日6次的预处理方案在没有肺屏蔽的情况下诱导约11%的IP发生率。屏蔽肺部以接收该剂量的50%将估计的发病率降低至约2.3%。因为肺可以得到充分的保护，我们建议不要使用白消安作为环磷酰胺分次TBI的替代品。(c)2005年爱思唯尔公司
Purpose: Total body irradiation (TBI) and chemotherapy are common components of conditioning regimens for bone marrow transplantation. Interstitial pneumonitis (IP) is a known regimen-related complication. Using published data of IP in a multivariate logistic regression, this study sought to identify the parameters in the bone marrow transplantation conditioning regimen that were significantly associated with IP and to establish a radiation dose-response function. Methods and Materials: A retrospective review was conducted of articles that reported IP incidence along with lung dose, fractionation, dose rate, and chemotherapy regimen. In the final analysis, 20 articles (n = 1090 patients), consisting of 26 distinct TBI/chemotherapy regimens, were included in the analysis. Multivariate logistic regression was performed to determine dosimetric and chemotherapeutic factors that influenced the incidence of IP. Results: A logistic model was generated from patients receiving daily fractions of radiation. In this model, lung dose, cyclophosphamide dose, and the addition of busulfan were significantly associated with IP. An incidence of 3%-4% with chemotherapy-only conditioning regimens is estimated from the models. The alpha/beta value of the linear-quadratic model was estimated to be 2.8 Gy. The dose eliciting a 50% incidence, D-50, for IP after 120 mg/kg of cyclophosphamide was 8.8 Gy; in the absence of chemotherapy, the estimated D-50 is 10.6 Gy. No dose rate effect was observed. The use of busulfan as a substitute for radiation is equivalent to treating with 14.8 Gy in 4 fractions with 50% transmission blocks shielding the lung. The logistic regression failed to find a model that adequately fit the multiple-fraction-per-day data. Conclusions: Dose responses for both lung radiation dose and cyclophosphamide dose were identified. A conditioning regimen of 12 Gy TBI in 6 daily fractions induces an IP incidence of about 11% in the absence of lung shielding. Shielding the lung to receive 50% of this dose lowers the estimated incidence to about 2.3%. Because the lungs can be adequately shielded, we recommend against using busulfan as a substitute for fractionated TBI with cyclophosphamide. (c) 2005 Elsevier Inc.