Korean J Intern Med.  2010 Mar;25(1):86-92. 10.3904/kjim.2010.25.1.86.

Severe Pulmonary Adverse Effects in Lymphoma Patients Treated with Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (CHOP) Regimen Plus Rituximab

• Lim KH
• Yoon HI
• Kang YA
• Lee KW
• Kim JH
• Bang SM
• Lee JH
• Lee CT
• Lee JS

• KMID: 1785660
• DOI: http://doi.org/10.3904/kjim.2010.25.1.86

Abstract

BACKGROUND/AIMS
The aim of our study was to determine the incidence and clinical features of severe pulmonary complications in patients receiving cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or rituximab plus CHOP (R-CHOP) as the initial treatment for lymphoma.
METHODS
A retrospective analysis of pulmonary infection and drug-induced interstitial pneumonitis (DIIP) was performed using lymphoma registry data. R-CHOP was administered in 71 patients and CHOP in 29 patients.
RESULTS
The severe pulmonary adverse events tended to occur more frequently with R-CHOP (18.3%) than CHOP alone (13.8%), although the difference was not significant (p = 0.771). DIIP occurred in five patients in the R-CHOP arm (7%) and in one in the CHOP arm (3%). The continuous use of steroids for conditions other than lymphoma significantly increased the risk of pulmonary infection including Pneumocystis jiroveci pneumonia (p = 0.036) in the multivariate analysis. International prognostic index, tumor stage, smoking, previous tuberculosis, chronic obstructive pulmonary disease, and lymphoma involvement of lung parenchyma were not related to pulmonary adverse events. Patients who experienced severe pulmonary events showed shorter survival when compared to those without complications (p = 0.002).
CONCLUSIONS
Our experiences with serial cases with DIIP during chemotherapy and the correlation of continuous steroid use with pulmonary infection suggest that the incidence of pulmonary complications might be high during lymphoma treatment, and careful monitoring should be performed.

Keyword

Rituximab; Drug therapy; Lymphoma, non-Hodgkin; Adverse effects; Lung diseases, interstitial

MeSH Terms

Adult
Aged
Aged, 80 and over
Antibodies, Monoclonal/administration & dosage/*adverse effects
Antineoplastic Combined Chemotherapy Protocols/administration & dosage/*adverse effects
Cyclophosphamide/administration & dosage/adverse effects
Doxorubicin/administration & dosage/adverse effects
Female
Humans
Incidence
Lung Diseases, Interstitial/*chemically induced/mortality
Lymphoma, Non-Hodgkin/*drug therapy/mortality
Male
Middle Aged
Pneumocystis jirovecii
Pneumonia, Bacterial/mortality
Pneumonia, Pneumocystis/mortality
Prednisone/administration & dosage/adverse effects
Retrospective Studies
Risk Factors
Severity of Illness Index
Tuberculosis, Pulmonary/mortality
Vincristine/administration & dosage/adverse effects
Young Adult