LETHAL PULMONARY TOXICITY AFTER AUTOLOGOUS BONE-MARROW TRANSPLANTATION PERIPHERAL-BLOOD STEM-CELL TRANSPLANTATION FOR HEMATOLOGICAL MALIGNANCIES

Background and purpose: Retrospective evaluation of the incidence of l ethal pulmonary complications (LPC) with special emphasis on interstit ial pneumonia (IP) in a large group of patients homogeneously treated with hyperfractionated total body irradiation (HTBI) before autologous bone marrow transplantation (ABMT) or peripheral blood stem cell tran splantation (PBSCT) for hematological malignancy. The factors influenc ing IP are discussed. Materials and methods: Of 260 patients (maximum follow-up 137 months) that were treated with ABMT or PBSCT for hematol ogical neoplasms between 1982 and 1994, 209 patients received HTBI and could be evaluated with respect to lethal pulmonary complications and especially lethal interstitial pneumonia. For most patients (n = 155) , the HTBI dose was 14.4 Gy (lung dose 9-9.5 Gy) given in 12 fractions over 4 days. Twenty-one patients received a total dose of greater tha n or equal to 15 Gy with pulmonary doses of 9-10.5 Gy. Results: The ac tuarial overall 5-year survival for all 209 patients evaluated was 44 +/- 4%, enabling valid evaluation with respect to lethal pulmonary tox icity. The actuarial incidence of all LPC during the first year was ca lculated as being 8 +/- 2%. The actuarial incidence of lethal IP is ce rtainly lower and was estimated to be between 3 and 5% for all patient s. The overall treatment-related mortality was 12% in 188 patients tha t received a total dose of <15 Gy and 24% among the patients treated w ith a total dose of greater than or equal to 15 Gy. Conclusion: ABMT/P BSCT, like other transplant modalities without significant graft versu s host disease (GvHD), has a low transplant related mortality, a very small rate of overall LPC and a low incidence of lethal IP after HTBI. Doses up to 14.4 Gy with lung doses of 9-9.5 Gy can be administered s afely. For total doses of greater than or equal to 15 Gy with lung dos es of 9-10.5 Gy, the risk of serious transplant-related complications cannot yet be finally assessed but such higher doses should be conside red with caution because of the possibility of increasing toxicity in organs other than the lung. (C) 1998 Elsevier Science ireland Ltd. All rights reserved.