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Laddaga FE, Moschetta M, Perrone T, Perrini S, Colonna P, Ingravallo G, D'abbicco D, Specchia G, Gaudio F. Long-term Hodgkin Lymphoma Survivors: A Glimpse of What Happens 10 Years After Treatment. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e506-e512. [PMID: 32381398 DOI: 10.1016/j.clml.2020.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION This retrospective study was focused on 96 patients (median age at diagnosis, 35 years) with newly diagnosed Hodgkin lymphoma (HL) treated at the University Hospital of Bari (Italy) between 2005 and 2008, to evaluate the outcome and the long-term toxicity. PATIENTS AND METHODS First-line chemotherapy was ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in all patients; 49 (51%) patients had undergone radiotherapy. At the end of treatment, 75 (78%) patients were in complete remission (CR); 18 (24%) of 75 patients relapsed after first-line treatment; 20 (21%) underwent autologous hematopoietic stem cell transplantation, and 3 (3%) underwent allogeneic stem cell transplantation. RESULTS After a median follow-up of 12 years, 85 (88%) patients are alive in CR, and 11 (14%) have died (2 of a second neoplasia, 1 of infection, and 8 of the disease). The 140-month Kaplan-Meier survival estimates were 86%. Three women became pregnant and each gave birth to a healthy child. The most prevalent chronic conditions at last follow-up were: a reduction in lung transfer factor for carbon monoxide (40%), fatigue (31%), hypothyroidism (30%), and infertility (16%). CONCLUSIONS Results of this study offer indications about how long after the initial treatment excess deaths from causes other than HL begin to occur. However, challenges remain, namely establishing the optimal time to begin screening for potential late complications and developing better surveillance guidelines. Further work is needed to identify risk factors that may predict specific late effects.
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Affiliation(s)
| | - Marco Moschetta
- Department of Emergency and Organ Transplantation (D.E.T.O.), Breast Unit, University of Bari, Bari, Italy
| | - Tommasina Perrone
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari, Bari, Italy
| | - Sebastio Perrini
- Department of Emergency and Organ Transplantation (D.E.T.O.), Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari, Bari, Italy
| | - Paolo Colonna
- Department of Cardiology, University Hospital Policlinico, Bari, Italy
| | - Giuseppe Ingravallo
- Department of Emergency and Organ Transplantation (D.E.T.O.), Pathology Section, University of Bari, Bari, Italy
| | - Dario D'abbicco
- Department of Emergency and Organ Transplantation (D.E.T.O.), Institute of General Surgery "G Marinaccio," University of Bari, Bari, Italy
| | - Giorgina Specchia
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari, Bari, Italy
| | - Francesco Gaudio
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari, Bari, Italy.
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Ciavarella S, Minoia C, Quinto AM, Oliva S, Carbonara S, Cormio C, Cox MC, Bravo E, Santoro F, Napolitano M, Spina M, Loseto G, Guarini A. Improving Provision of Care for Long-term Survivors of Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:e1-e9. [PMID: 28916153 DOI: 10.1016/j.clml.2017.08.097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/21/2017] [Accepted: 08/07/2017] [Indexed: 12/11/2022]
Abstract
The progressive improvement of lymphoma therapies has led to a significant prolongation of patient survival and life expectancy. However, lymphoma survivors are at high risk of experiencing a range of early and late adverse effects associated with the extent of treatment exposure. Among these, second malignancies and cardiopulmonary diseases can be fatal, and neurocognitive dysfunction, endocrinopathy, muscle atrophy, and persistent fatigue can affect patients' quality of life for decades after treatment. Early recognition and reduction of risk factors and proper monitoring and treatment of these complications require well-defined follow-up criteria, close coordination among specialists of different disciplines, and a tailored model of survivorship care. We have summarized the major aspects of therapy-related effects in lymphoma patients, reviewed the current recommendations for follow-up protocols, and described a new hospital-based model of survivorship care provision from a recent multicenter Italian experience.
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Affiliation(s)
- Sabino Ciavarella
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy.
| | - Carla Minoia
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Angela Maria Quinto
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Stefano Oliva
- Cardiology Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Santa Carbonara
- Cardiology Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Claudia Cormio
- Psycho-oncology Service, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Maria Christina Cox
- Hematology Unit, Azienda Ospedaliera-Universitaria "Sant'Andrea", Rome, Italy
| | - Elena Bravo
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Filippo Santoro
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | | | - Michele Spina
- IRCCS-Centro di Riferimento Oncologico di Aviano, Aviano, Italy
| | - Giacomo Loseto
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Attilio Guarini
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
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Abstract
A 32-year-old man underwent an F-18 fluordeoxyglucose positron emission tomography (FDG-PET/CT) scan for response assessment of mediastinal bulky non-Hodgkin lymphoma after completion of a CHOP therapy regimen. The F-18 FDG-PET/CT scan showed complete response regarding the mediastinal lesion. However, an unexpected pattern of prominent lung and abdominal muscular uptake was detected. The patient's clinical history was reassessed for differential diagnosis purposes. The medical records confirmed an episode of self-resolved influenza-like infection 4 days before the PET scan.This case underlines the importance of careful history taking before interpretation of PET scans. Viral infections should be included in the differential diagnosis of pulmonary diffuse F-18 FDG uptake.
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Drug-induced pneumonitis detected earlier by 18F-FDG-PET than by high-resolution CT: a case report with non-Hodgkin's lymphoma. Ann Nucl Med 2008; 22:719-22. [PMID: 18982476 DOI: 10.1007/s12149-008-0183-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Accepted: 01/25/2008] [Indexed: 11/27/2022]
Abstract
Drug-induced pneumonitis is a serious and an unpredictable side effect of chemotherapy in patients with malignant lymphoma. We present the case of a 51-year-old man who developed drug-induced pneumonitis during chemotherapy for non-Hodgkin's lymphoma in which pneumonitis was detected earlier by 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) than by high-resolution computed tomography (HRCT). After five courses of chemotherapy, 18F-FDG-PET was performed for assessing residual lesions, and diffuse lung uptake was incidentally observed. No symptoms were present, and HRCT performed immediately following PET revealed no abnormalities. Mild dyspnea appeared 3 days after PET, and additional HRCT revealed patchy ground-glass opacities disseminated with the appearance of interlobular septum thickening. Drug-induced pneumonitis was finally diagnosed, and treatment was initiated. 18F-FDG-PET can be an imaging modality for detecting drug-induced pneumonitis at an extremely early stage in which HRCT is incapable of revealing any abnormal changes.
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Smith SW, Nelson LS. Case files of the New York City Poison Control Center: antidotal strategies for the management of methotrexate toxicity. J Med Toxicol 2008; 4:132-40. [PMID: 18570175 PMCID: PMC3550133 DOI: 10.1007/bf03160968] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Silas W Smith
- New York City Poison Control Center, New York, NY, USA.
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6
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Moody AM, Pratt J, Hudson GV, Smith P, Lamont A, Williams MV. British National Lymphoma Investigation: pilot studies of neoadjuvant chemotherapy in clinical stage Ia and IIa Hodgkin's disease. Clin Oncol (R Coll Radiol) 2002; 13:262-8. [PMID: 11554622 DOI: 10.1053/clon.2001.9265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In order to improve treatment in early Stage IA and IIA Hodgkin's disease, the British National Lymphoma Investigation (BNLI) has evaluated two neoadjuvant chemotherapy regimens with involved field radiotherapy. This article reports the results of the methotrexate, vinblastine and prednisolone (MVP) study in 39 patients and updates the previous report on vinblastine, bleomycin and methotrexate (VBM) in 30 patients. Both studies recruited clinical Stage IA or IIA Hodgkin's disease patients with intermediate risk of relapse into a prospective multicentre Phase II study. They received two cycles of chemotherapy followed by involved field radiotherapy and then four further cycles of chemotherapy. For MVP the 5-year survival is 97% and for VBM it is 93%. The 5-year event-free survival rates are 71% and 87% respectively. The acute pulmonary and haematological toxicity occurring with VBM was not acceptable and therefore the MVP study was performed. There was less toxicity with this regimen although modest acute pulmonary toxicity was still observed. However, in view of the length of treatment with MVP (9 months) and the excellent results reported by the Manchester group, future efforts of the BNLI are to be directed towards a new short course chemotherapy regimen, VAPEC-B (vincristine, doxorubicin, prednisolone, etoposide, cyclophosphamide and bleomycin).
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Affiliation(s)
- A M Moody
- Oncology Centre, Addenbrooke's NHS Trust, Cambridge, UK
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Affiliation(s)
- R Epelbaum
- Department of Oncology, Rambam Medical Center, Haifa, Israel
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8
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Tilly H, Mounier N, Lederlin P, Brière J, Dupriez B, Sebban C, Bosly A, Biron P, Nouvel C, Herbrecht R, Bordessoule D, Coiffier B. Randomized comparison of ACVBP and m-BACOD in the treatment of patients with low-risk aggressive lymphoma: the LNH87-1 study. Groupe d'Etudes des Lymphomes de l'Adulte. J Clin Oncol 2000; 18:1309-15. [PMID: 10715302 DOI: 10.1200/jco.2000.18.6.1309] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare a short intensified regimen followed by sequential consolidation therapy (doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone [ACVBP]) to the standard regimen of methotrexate, bleomycin, cyclophosphamide, and etoposide (m-BACOD) in patients with low-risk aggressive lymphoma. PATIENTS AND METHODS A total of 752 patients with intermediate- or high-grade lymphoma and no adverse prognostic factors (Eastern Cooperative Oncology Group performance status of 2 to 4, >/= two extranodal sites of disease, tumor burden >/= 10 cm in largest dimension, bone marrow or CNS involvement, Burkitt's or lymphoblastic subtypes) were registered. Of 673 eligible patients, 332 received ACVBP and 341 received m-BACOD. RESULTS The complete remission rate was identical (86%) in the two groups. With a median follow-up duration of 7 years, the 5-year failure-free survival (FFS) rate was 65% in the ACVBP group and 61% in the m-BACOD group (P =.16). The 5-year overall survival rate was 75% in the ACVBP group and 73% in the m-BACOD group (P =.47). ACVBP was responsible for more severe and life-threatening infections (P <.01), but m-BACOD caused more pulmonary toxicity (P <.001). The number of treatment-related deaths did not differ between the two regimens. A multivariate analysis indicated that ACVBP was associated with a longer FFS in patients with two or three risk factors of the International Prognostic Index. CONCLUSION In this population of patients with low-risk aggressive lymphoma, toxicities of the regimens are different, but the rates of response and survival are identical. The survival advantage of ACVBP over standard regimen in patients with advanced disease is suggested by this analysis but remains to be assessed in prospective studies specifically designed for this purpose.
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Affiliation(s)
- H Tilly
- Centre Henri Becquerel, Rouen, France.
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9
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Yokose N, Ogata K, Tamura H, An E, Nakamura K, Kamikubo K, Kudoh S, Dan K, Nomura T. Pulmonary toxicity after granulocyte colony-stimulating factor-combined chemotherapy for non-Hodgkin's lymphoma. Br J Cancer 1998; 77:2286-90. [PMID: 9649147 PMCID: PMC2150381 DOI: 10.1038/bjc.1998.380] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Sporadic cases have developed pulmonary toxicity after receiving chemotherapy and granulocyte colony-stimulating factor (G-CSF). However, because such cases received chemotherapy that alone frequently causes pulmonary toxicity, the role of G-CSF in this toxicity has been unclear. CHOP therapy (cyclophosphamide, doxorubicin, vincristine and prednisolone) only slightly induces pulmonary toxicity. However, we observed a considerable incidence of this toxicity in non-Hodgkin's lymphoma subjects receiving CHOP therapy and G-CSF (6 out of 52 subjects, 11.5%). In this cohort, among various characteristics, including the dose and interval of CHOP therapy, only the mean peak leucocyte count (MPLC) with each therapy cycle was associated with development of this toxicity (MPLC > or = 23.0 x 10(9) l(-1), 6 out of 29 cases; MPLC < 23.0 x 10(9) l(-1), 0 out of 23 cases; P = 0.020). These findings suggest that the effect of G-CSF is the main determinant of the pulmonary toxicity in these cases. Because the toxicity was associated with a large MPLC and did not recur in cases readministered G-CSF, an idiosyncratic reaction to G-CSF is unlikely to be the pathogenesis of this toxicity. Thus, lowering the G-CSF dose seems to be useful in the prevention of this toxicity. In all six cases, the time course of manifestation of the toxicity was the same, and early application of high-dose corticosteroid led to cure. This knowledge will be helpful in the care of similar cases.
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Affiliation(s)
- N Yokose
- Department of Medicine, Nippon Medical School, Tokyo, Japan
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Abstract
PURPOSE The outcome of treatment of 98 over 70-year-old patients with nonHodgkin's lymphoma (NHL) is presented. METHODS AND MATERIALS Analysis of treatment outcome of non-Hodgkin's lymphoma patients age 70 years and more was carried through with special emphasis on fatal complications occurring during treatment. Study patients mainly represented intermediate or high degree of malignancy. RESULTS Complete response rate (CR) was 54% after combination chemotherapy, 22% after single agent chemotherapy, and 56% after radiotherapy (used for local disease). The overall 5-year survival was 38% for all patients and 57% for CR patients. Stage had a significant effect on both the complete response rate and survival. Survival was also significantly influenced by the malignancy grade. Fifteen patients (15%) died during treatment, many of them had another predisposing disease and markers of poor prognosis. CONCLUSION The evaluation of individual prognostic features of each old patient should be completed prior to treatment planning.
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Affiliation(s)
- E K Salminen
- Department of Oncology and Radiotherapy, Turku University Hospital, Finland
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11
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Fauroux B, Meyer-Milsztain A, Boccon-Gibod L, Leverger G, Clément A, Biour M, Tournier G. Cytotoxic drug-induced pulmonary disease in infants and children. Pediatr Pulmonol 1994; 18:347-55. [PMID: 7892068 DOI: 10.1002/ppul.1950180602] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The increased survival rate of malignant diseases due to more aggressive treatments contributes to the occurrence of drug-induced pulmonary diseases (DIPD). We reviewed, retrospectively over a 10-year period, 15 children (8 girls) who presented a DIPD. Their mean age was 9 years (range, 1 to 17 years), with an underlying malignant disease in 14 (9 leukemias). Three typical patterns have emerged from this analysis: (1) acute hypersensitivity lung disease caused by methotrexate (in 6 patients) or azathioprine (in 1 patient). This acute syndrome consisted of alveolar-interstitial infiltrate with a hypercellularity on bronchoalveolar lavage (BAL) (mean, 714,286 cells/mL; range, 180,000-2,940,000 cells/mL) and an increase of lymphocyte counts (mean, 39%; range 11-64%) with predominantly CD8-suppressor/cytotoxic lymphocytes. Inhibition of leukocyte migration or leukocyte aggregation in the presence of low drug concentrations was positive in the 5 cases tested. Lung function tests showed a restrictive pattern and the outcome of DIPD was always favorable. (2) Chronic pneumonitis/fibrosis was seen in 6 patients who received a variable association of cyclophosphamide (3 patients), bleomycin (2 patients), BCNU (2 patients), and melphalan (1 patient). Symptoms of an alveolar-interstitial pneumonitis developed progressively. BAL showed a moderate increase of total cell numbers (mean, 495,000 cells/mL; range, 150,000-900,000 cells/mL). Lung function tests showed a restrictive pattern. Despite corticosteroid treatment in 4 children, one died after bleomycin lung injury and 2 had functional lung impairment. (3) Noncardiogenic pulmonary edema occurred in 2 patients with leukemia treated with recombinant interleukin II. BAL showed hypercellularity and outcome was rapidly favorable.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- B Fauroux
- Department of Pediatric Pulmonology, Hôpital d'Enfants Armand Trousseau, Paris, France
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12
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Lei KI, Leung WT, Johnson PJ. Serious pulmonary complications in patients receiving recombinant granulocyte colony-stimulating factor during BACOP chemotherapy for aggressive non-Hodgkin's lymphoma. Br J Cancer 1994; 70:1009-13. [PMID: 7524599 PMCID: PMC2033539 DOI: 10.1038/bjc.1994.439] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Four of 12 Chinese patients receiving BACOP, in combination with recombinant human granulocyte colony-stimulating factor, for aggressive non-Hodgkin's lymphoma developed a rapidly progressive pneumonic illness characterised by diffuse pulmonary infiltrates and hypoxaemia. The condition proved fatal in three, and in none could an infective cause be identified. A retrospective analysis revealed only one episode of pneumonia in the previous 24 patients in whom the same BACOP regimen was administered without granulocyte colony-stimulating factor support. Granulocyte colony-stimulating factor, by augmenting white cell production, pulmonary sequestration and margination and production of toxic oxygen species, may exacerbate underlying subclinical bleomycin pulmonary toxicity. Caution should be exercised before using granulocyte-stimulating factors in bleomycin-containing regimens.
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Affiliation(s)
- K I Lei
- Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT
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Bhardwaj JR, Kartik K, Sambandam S. PULMONARY LESIONS ASSOCIATED WITH BLEOMYCIN THERAPY IN MALIGNANCIES. Med J Armed Forces India 1994; 50:167-170. [PMID: 28769196 DOI: 10.1016/s0377-1237(17)31052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Pulmonary lesions in seven patients with malignancy who were treated with bleomycin were studied at autopsy. Six of them had symptoms of respiratory distress. The lesions showed a predilection for the lower lobe and subpleural zones. Diffuse alveolar damage progressing to interstitial pneumonitis at varying stages of evolution was observed in all cases. The changes included intra-alveolar proteinaceous exudate, extensive interstitial fibrosis and frank epithelial dysplasia simulating metastatic nodules.
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Affiliation(s)
| | - K Kartik
- PG Student; Department of Pathology, Armed Forces Medical College, Pune-411 040
| | - S Sambandam
- Formerly Consultant in Radiotherapy, Command Hospital (SC), Pune-411 040
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14
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Abstract
Drug-induced disease of any system or organ can be associated with high morbidity and mortality, and it is tremendously costly to the health care of our country. More than 100 medications are known to affect the lungs adversely, including the airways in the form of cough and asthma, the interstitium with interstitial pneumonitis and noncardiac pulmonary edema, and the pleura with pleural effusions. Patients commonly do not even know what medications they are taking, do not bring them to the physician's office for identification, and usually do not relate over-the-counter medications with any problems they have. They assume that all nonprescription drugs are safe. Patients also believe that if they are taking prescription medications at their discretion, meaning on an as-needed basis, then these medications are also not important. This situation stresses just how imperative it is for the physician to take an accurate drug history in all patients seen with unexplained medical situations. Cardiovascular drugs that most commonly produce a pulmonary abnormality are amiodarone, the angiotensin-converting enzyme inhibitors, and beta-blockers. Pulmonary complications will develop in 6% of patients taking amiodarone and 15% taking angiotensin-converting enzyme inhibitors, with the former associated with interstitial pneumonitis that can be fatal and the latter associated with an irritating cough that is not associated with any pathologic or physiologic sequelae of consequence. The beta-blockers can aggravate obstructive lung disease in any patient taking them. Of the antiinflammatory agents, acetylsalicyclic acid can produce several different airway and parenchymal complications, including aggrevation of asthma in up to 5% of patients with asthma, a noncardiac pulmonary edema when levels exceed 40 mg/dl, and a pseudosepsis syndrome. More than 200 products contain aspirin. Low-dose methotrexate is proving to be a problem because granulomatous interstitial pneumonitis develops in 5% of those patients receiving it. This condition occurs most often in patients receiving the drug for rheumatoid arthritis, but it has been reported in a few patients receiving it for refractory asthma. Chemotherapeutic drug-induced lung disease is almost always associated with fever, thus mimicking opportunistic infection, which is the most common cause of pulmonary complications in the immunocompromised host. However, in 10% to 15% of patients, the pulmonary infiltrate is due to an adverse effect from a chemotherapeutic agent. This complication is frequently fatal even when recognized early.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- E C Rosenow
- Division of Pulmonary Diseases, Mayo Clinic, Rochester, Minnesota
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15
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Iki S, Yoshinaga K, Ohbayashi Y, Urabe A. Cytotoxic drug-induced pneumonia and possible augmentation by G-CSF--clinical attention. Ann Hematol 1993; 66:217-8. [PMID: 7683499 DOI: 10.1007/bf01703240] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Ngan HY, Liang RH, Lam WK, Chan TK. Pulmonary toxicity in patients with non-Hodgkin's lymphoma treated with bleomycin-containing combination chemotherapy. Cancer Chemother Pharmacol 1993; 32:407-9. [PMID: 7687934 DOI: 10.1007/bf00735929] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Subclinical and clinical bleomycin-induced pulmonary toxicity (BIP) were investigated retrospectively in 109 patients with non-Hodgkin's lymphoma treated by combination chemotherapy containing bleomycin. A decrease in carbon monoxide diffusing capacity (DLCO) was found in 12.8% of patients. The cumulative risk of abnormal DLCO increased with the increasing total cumulative dose of bleomycin. No significant difference in the rate of BIP was observed between patients receiving bleomycin/Adriamycin/cyclophosphamide/vincristine/prednisone (BACOP; bleomycin given at 10 mg/m2 for 4 weeks) and bleomycin/Adriamycin/cyclophosphamide/vincristine/dexamethasone/methotre xate/ folinic acid (m-BACOD; bleomycin given at 4 mg/m2 for 3 weeks, methotrexate given at 200 mg/m2. Monitoring for subclinical BIP should be considered in patients with non-Hodgkin's lymphoma even if only a low dose of bleomycin was given in the presence of other chemotherapeutic agents.
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Affiliation(s)
- H Y Ngan
- Department of Obstetrics and Gynaecology, University of Hong Kong, Queen Mary Hospital
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