Tuberc Respir Dis.  1999 Jul;47(1):77-89. 10.4046/trd.1999.47.1.77.

Pulmonary Toxicity Following High-Dose Chemotherapy With Peripheral Blood Stem Cell Transplantation

• Lee SM
• Park KJ
• Oh YJ
• Cheong SC
• Hwang SC
• Lee YH
• Kim HS
• Lim HY
• Kim HC
• Yim H
• Hahn MH

• KMID: 2050162
• DOI: http://doi.org/10.4046/trd.1999.47.1.77

Abstract

BACKGROUND: High-dose chemotherapy is increasingly employed in many refractory malignant diseases. This therapy has been reported to increase response rate and survival benefits but it is also associated with higher treatment-related morbidity and mortality. We evaluated clinical characteristics and course of the pulmonary toxicity following high-dose chemotherapy with peripheral blood stem cell transplantation.
METHODS
Ninety-seven patients who had received high-dose chemotherapy with peripheral blood stem cell transplantation were evaluated. Five patients who developed lung lesions which were not related to infection nor primary malignant disease underwent transbronchial lung biopsy. The patients' clinical characteristics, treatments, and prognosis were reviewed retrospectively.
RESULTS
Five patients(5.1%) developed idiopathic pneumonia syndrome. The high dose chemotherapy regimens employed were cyclophosphamide, BCNU, and cisplatin in 3 cases, one case of BCNU, etoposide, Ara-C, cyclophosphamide combination, and a regimen consisting of BCNU, etoposide, Ara-C, and melphalan. The total dose of BCNU used was 300-400 mg/m2 and that of cyclophosphsmide was 6,000 mg/m2. All of 5 patients received radiation therapy before this treatment. After an average duration of 14 weeks (4-26 weeks) of high-dose chemotherapy, patients developed cough, dyspnea and fever. The chest X-rays showed bilateral diffuse infiltration in 3 cases and the focal infiltration in the other 2 cases. All the patients received corticosteroid therapy as a treatment for the lung lesions. Two of them progressed to acute respiratory distress syndrome and died. Three patients recovered without residual lung lesion but one of them died of dilated cardiomyopathy.
CONCLUSION
High-dose chemotherapy with peripheral blood stem cell transplantation especially which containing BCNU regimen may develop idiopathic pneumonia syndrome related to pulmonary toxicity and corticosteroid therapy may be beneficial in some cases.

Keyword

High-dose chemotherapy; BCNU; Idiopathic pneumonia syndrome; Drug toxicity

MeSH Terms

Biopsy
Cardiomyopathy, Dilated
Carmustine
Cisplatin
Cough
Cyclophosphamide
Cytarabine
Drug Therapy*
Drug-Related Side Effects and Adverse Reactions
Dyspnea
Etoposide
Fever
Humans
Lung
Melphalan
Mortality
Peripheral Blood Stem Cell Transplantation*
Pneumonia
Prognosis
Respiratory Distress Syndrome, Adult
Retrospective Studies
Thorax
Carmustine
Cisplatin
Cyclophosphamide
Cytarabine
Etoposide
Melphalan