Latini P, Aristei C, Aversa F, Checcaglini F, Maranzano E, Panizza B M, Perrucci E, Carotti A, Martelli M F
Radiation Oncology Service, Policlinico Monteluce, Perugia, Italy.
Int J Radiat Oncol Biol Phys. 1992;23(2):401-5. doi: 10.1016/0360-3016(92)90760-f.
Interstitial pneumonia is one of the major causes of morbidity and mortality after bone-marrow transplantation. We here report a series of 58 patients suffering from hematological malignancies who received HLA-matched T-lymphocyte depleted bone-marrow transplants between July 1985 and January 1990. Interstitial pneumonia occurred in 7/58 patients (12%) and was fatal in six. Three different pre-bone-marrow transplantation conditioning regimens were employed. Total body irradiation was delivered according to a hyperfractionated scheme of 12 fractions given three per day 5 hr apart for 4 days. Twenty-three patients received 36 mg/Kg procarbazine, 1275 UL/Kg antithymocite globulin, 14.4 Gy hyperfractionated total body irradiation and 120 mg/Kg cyclophosphamide. Only one patient developed interstitial pneumonia, but two rejected the graft and 10 relapsed. As a consequence, the total hyperfractionated scheme was increased to 15,6 Gy, cyclophosphamide to 200 mg/Kg, antithymocite globulin to 3400 UL/Kg and procarbazine eliminated. There were three cases of interstitial pneumonia, no rejection and four relapses in the 17 patients who received this regimen. In the last 18 patients hyperfractionated total body irradiation was reduced to 15 Gy, cyclophosphamide to 100 mg/Kg, and 10 mg/Kg of the myeloablative agent thiothepa added to enhance the cytoreductive effect without significantly increasing extramedullary toxicity. Three cases of interstitial pneumonia, one relapse but no rejection were recorded. Our results demonstrate that the absence of graft-versus-host disease due to T-cell depletion, and radio-chemotherapy doses and schedules used for the conditioning regimen each contributed to reducing the risk of interstitial pneumonitis. Hyperfractionated total body irradiation therefore, seems to play an important role in lowering the incidence of this complication.
间质性肺炎是骨髓移植后发病和死亡的主要原因之一。我们在此报告了1985年7月至1990年1月期间接受HLA配型相合的去除T淋巴细胞的骨髓移植的58例血液系统恶性肿瘤患者。58例患者中有7例（12%）发生间质性肺炎，其中6例死亡。采用了三种不同的骨髓移植前预处理方案。全身照射按照超分割方案进行，共12次分割，每天3次，每次间隔5小时，持续4天。23例患者接受了36mg/kg丙卡巴肼、1275U/kg抗胸腺细胞球蛋白、14.4Gy超分割全身照射和120mg/kg环磷酰胺。仅1例患者发生间质性肺炎，但2例出现移植物排斥，10例复发。因此，超分割方案总量增加至15.6Gy，环磷酰胺增加至200mg/kg，抗胸腺细胞球蛋白增加至3400U/kg，并取消了丙卡巴肼。接受该方案的17例患者中有3例发生间质性肺炎，无移植物排斥，4例复发。在最后18例患者中，超分割全身照射减少至15Gy，环磷酰胺减少至100mg/kg，并添加10mg/kg的清髓药物噻替派以增强细胞减灭效果，同时不显著增加髓外毒性。记录到3例间质性肺炎，1例复发，但无移植物排斥。我们的结果表明，由于T细胞去除导致的移植物抗宿主病的缺失，以及预处理方案中使用的放化疗剂量和时间表，均有助于降低间质性肺炎的风险。因此，超分割全身照射似乎在降低这种并发症的发生率方面发挥着重要作用。
