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Finch K, Sharma D, Wagner S. Lenalidomide induced pneumonitis. J Oncol Pharm Pract 2022:10781552221124533. [PMID: 36071644 DOI: 10.1177/10781552221124533] [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: 11/17/2022]
Abstract
INTRODUCTION Iatrogenic lung injury is a very rare, albeit serious complication with antineoplastic therapy, including immunomodulatory drugs. Pneumonitis typically presents clinically with symptoms such as cough, dyspnea, fever, and hypoxemia. Radiographic evaluation often demonstrates diffuse, patchy infiltrates and ground-glass opacities. CASE REPORT We present a case in which therapy from an immunomodulatory drug, lenalidomide, elicited a pneumonitis in the form of a 9 cm lung mass. An exhaustive workup was completed to rule out viral, bacterial, and fungal infections as well as malignant causes. Lenalidomide-induced lung injury was suspected. MANAGEMENT AND OUTCOME Lenalidomide was discontinued and corticosteroid therapy was initiated. This resulted in a complete clinical and radiographic resolution of symptoms. DISCUSSION Several case reports of pneumonitis have been associated with immunomodulatory drug therapy, and while most of these exhibit diffuse ground-glass opacities radiographically, our patient presented with a 9 cm lung mass. Our findings stress the importance of a thorough medication review while ruling out other potential causes of lung injury.
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Affiliation(s)
- Kelsey Finch
- Lung Institute, 14479Columbus Regional Health, Columbus, IN, USA
| | - Deepankar Sharma
- Lung Institute, 14479Columbus Regional Health, Columbus, IN, USA
| | - Stephanie Wagner
- Lung Institute, 14479Columbus Regional Health, Columbus, IN, USA
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Zeng H, Ma Y, He X, Cai S, Chen P, Chen Y, Luo H. Characteristics and Follow-Up of Organizing Pneumonia Associated with Haematological Malignancies. Int J Gen Med 2022; 15:301-310. [PMID: 35027840 PMCID: PMC8752074 DOI: 10.2147/ijgm.s337321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Organizing pneumonia (OP) is a secondary process in many diseases. Due to its low incidence and indistinct symptoms, there is limited information on OP associated with haematological malignancies. Therefore, the aim of this study was to discuss the characteristics and prognosis of OP associated with haematological malignancies. Methods We observed and analysed pathologically confirmed OP cases associated with haematological malignancies in a hospital record database and excluded cases of OP with known causes, including chemotherapy, radiotherapy, targeted therapy, transplantation and infection. Results There were five patients with OP underlying only haematological malignancies, including one case each of the following: myelodysplastic syndrome, acute myelogenous leukaemia, multiple myeloma, aplastic anaemia, and T cell lymphoma. Radiological findings did not show a distinct pattern, and two cases mimicked pulmonary aspergillosis with ground-glass opacity (GGO). The diagnosis of OP was confirmed by minimal invasive biopsy. Although all patients developed severe cases, steroids yielded favourable outcomes. Conclusion This study demonstrates that haematological malignancies may be a cause of OP and that minimal invasive biopsy may be an effective and safe method to confirm the diagnosis. Although OP associated with haematological malignancies may more frequently develop into severe cases, the OP lesions were steroid-responsive during follow-up.
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Affiliation(s)
- Huihui Zeng
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Yiming Ma
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Xue He
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Shan Cai
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Ping Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Yan Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Hong Luo
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
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Parrot A, Gibelin A, Issoufaly T, Voiriot G, Djibré M, Naccache J, Cadranel J, Fartoukh M. Toxicité pulmonaire des médicaments : ce que le réanimateur doit connaître ? MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Toma A, Rapoport AP, Burke A, Sachdeva A. Lenalidomide-induced eosinophilic pneumonia. Respirol Case Rep 2017; 5:e00233. [PMID: 28451433 PMCID: PMC5404234 DOI: 10.1002/rcr2.233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 02/26/2017] [Accepted: 03/13/2017] [Indexed: 12/03/2022] Open
Abstract
Multiple myeloma is a plasma cell dyscrasia accounting for 10% of haematologic malignancies. Lenalidomide is an immunomodulatory drug analogous to thalidomide that is approved for use in patients with myelodysplastic syndrome, and in combination with dexamethasone for refractory or relapsed multiple myeloma. Lenalidomide is preferred to thalidomide because of reduced toxicity, and pulmonary side effects are considered rare. We present, to our knowledge, an unusual and first reported case of a patient with relapsed multiple myeloma who received lenalidomide after autologous stem cell transplant, then developed eosinophilic pneumonia presenting as dyspnoea, peripheral eosinophilia, and bilateral pulmonary opacities. Bronchoscopy with bronchoalveolar lavage was negative for infection, and transbronchial lung biopsies showed eosinophilic pneumonia. After discontinuation of lenalidomide and initiation of prednisone therapy, his dyspnoea improved and eosinophilia resolved; however, symptoms recurred when the drug was restarted at a lower dose, confirming its causative role. In the absence of infection, clinicians should always bear in mind drug toxicity in the differential diagnosis of patients receiving lenalidomide and related agents.
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Affiliation(s)
| | - Aaron P. Rapoport
- Division of Hematology and OncologyUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Allen Burke
- Department of Anatomic pathologyUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Ashutosh Sachdeva
- Division of Pulmonary and Critical CareUniversity of Maryland School of MedicineBaltimoreMDUSA
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Snowden JA, Greenfield DM, Bird JM, Boland E, Bowcock S, Fisher A, Low E, Morris M, Yong K, Pratt G. Guidelines for screening and management of late and long-term consequences of myeloma and its treatment. Br J Haematol 2017; 176:888-907. [PMID: 28107574 DOI: 10.1111/bjh.14514] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A growing population of long-term survivors of myeloma is now accumulating the 'late effects' not only of myeloma itself, but also of several lines of treatment given throughout the course of the disease. It is thus important to recognise the cumulative burden of the disease and treatment-related toxicity in both the stable and active phases of myeloma, some of which is unlikely to be detected by routine monitoring. We summarise here the evidence for the key late effects in long-term survivors of myeloma, including physical and psychosocial consequences (in Parts 1 and 2 respectively), and recommend the use of late-effects screening protocols in detection and intervention. The early recognition of late effects and effective management strategies should lead to an improvement in the management of myeloma patients, although evidence in this area is currently limited and further research is warranted.
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Affiliation(s)
- John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Diana M Greenfield
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Department of Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jennifer M Bird
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Elaine Boland
- Palliative Medicine, Queen's Centre for Oncology and Haematology, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Stella Bowcock
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Kwee Yong
- University College London, London, UK
| | - Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Karaman A, Omeroglu M, Emet M, Kerget B, Subasi ID, Alper F. Lenalidomide Induced Late-Onset Acute Respiratory Distress Syndrome. Eurasian J Med 2016; 48:228-229. [PMID: 28149152 DOI: 10.5152/eurasianjmed.2015.0150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 10/16/2015] [Indexed: 12/20/2022] Open
Abstract
A 77-year-old man with multiple myeloma (MM) presented with shortness of breath to the emergency department. He also had history of chronic obstructive pulmonary disease, chronic pulmonary embolism and nephrectomy due to malignancy 10 years ago. He had been treated for 9 months with lenalidomide because of MM. He diagnosed with adult respiratory distress syndrome due to lenalidomide. We aimed to demonstrate late onset and destructive effects of lenalidomide on the lungs.
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Affiliation(s)
- Adem Karaman
- Department of Radiology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Mevlana Omeroglu
- Department of Emergency Medicine, Ataturk University School of Medicine, Erzurum, Turkey
| | - Mucahit Emet
- Department of Emergency Medicine, Ataturk University School of Medicine, Erzurum, Turkey
| | - Bugra Kerget
- Department of Pulmonology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Irmak Durur Subasi
- Department of Radiology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Fatih Alper
- Department of Radiology, Ataturk University School of Medicine, Erzurum, Turkey
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