Abstract
Sixty-five patients with hematological malignancies (25 multiple myeloma, 18 Hodgkin's disease, 22 non-Hodgkin's lymphomas) who received a carmustine-based regimen followed by autologous PBPC transplantation, were studied retrospectively to evaluate the incidence of post-transplant non-infective pulmonary complications (NIPCs), risk factors predictive of NIPCs, and response to steroids. Carmustine (BCNU) given i.v. at a dose of 600 mg/m2 was combined with etoposide and cyclophosphamide in 40 patients (BCV regimen) and with etoposide and melphalan in 25 patients (BEM regimen). Seventeen of 65 patients (26%) had one episode of NIPCs. The median time to NIPCs was 90 days (52–289). Factors that increased the risk of developing NIPCs on multivariate analysis were female sex (P < 0.001) and BCV regimen (P < 0.05). All patients with NIPCs received prednisone at a dose of 1 mg/kg body weight for 10 days then tapered by 5 mg every two days; complete response to steroids was achieved in 15 of 17 patients; one unresponsive patient died of interstitial pneumonia. BCNU given at the dose of 600 mg/m2 is well tolerated when associated with melphalan and etoposide. In females and in patients receiving BCNU with cyclophosphamide, a BCNU dose reduction may be advisable. Bone Marrow Transplantation (2000) 25, 309–313.
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References
Kreisman H, Wolkove N . Pulmonary toxicity of antineoplastic therapy Semin Oncol 1992 19: 508–520
Stahl W, Eisenbrand G . Comparative study on the influence of two 2-chloroethylnitrosoureas with different carbamoylating potential towards glutathione and glutathione-related enzymes in different organs of the rat Free Rad Res Comms 1991 14: 271–278
Cagnoni PJ, Nieto Y, Shpall EJ et al. High-dose chemotherapy with autologous hemopoietic progenitor-cell support as part of combined modality therapy in patients with inflammatory breast cancer J Clin Oncol 1998 16: 1661–1668
Rubio C, Hill ME, Milan S et al. Idiopathic pneumonia syndrome after high dose chemotherapy for relapsed Hodgkin's disease Br J Cancer 1997 75: 1044–1048
Ager S, Mahendra P, Richards EM et al. High dose carmustine, etoposide and melphalan (‘BEM’) with autologous stem cell transplantation: a dose–toxicity study Bone Marrow Transplant 1996 17: 335–340
Phillips GL, Fay JW, Herzing GP et al. Intensive 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU), NSC 436650 and cryopreserved autologous marrow transplantation for refractory cancer: a phase I–II study Cancer 1983 52: 1792–1802
Selker RG, Jacobs SA, Moore PB et al. 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) induced pulmonary fibrosis Neurosurgery 1980 7: 560–565
Wilczynski SW, Erasmus JJ, Petros WP et al. Delayed pulmonary toxicity syndrome following high dose chemotherapy and bone marrow transplantation for breast cancer Am J Respir Crit Care Med, 1998 157: 565–573
Reece DE, Connors JM, Spinelli JJ et al. Intensive therapy with cyclophosphamide, carmustine, etoposide, cisplatin and autologous bone marrow transplantation for Hodgkin's disease in first relapse after combination chemotherapy Blood 1994 83: 1193–1199
Weaver CH, Appelbaum FR, Petersen FB et al. High dose cyclophosphamide, carmustine, and etoposide followed by autologous bone marrow transplantation in patients with lymphoid malignancies who have received dose limiting radiation therapy J Clin Oncol 1993 11: 1329–1335
Wheeler C, Antin JH, Churchill WH et al. Cyclophosphamide, carmustine and etoposide with autologous bone marrow transplantation in refractory Hodgkin's disease and non Hodgkin's lymphoma: a dose finding study J Clin Oncol 1990 8: 648–656
Seiden MV, Elias A, Ayash L et al. Pulmonary toxicity associated with high dose chemotherapy in the treatment of solid tumors with autologous marrow transplant: an analysis of four chemotherapy regimen Bone Marrow Transplant 1992 10: 57–63
Chap L, Shpiner R, Levine N et al. Pulmonary toxicity of high dose chemotherapy for breast cancer: a non-invasive approach to diagnosis and treatment Bone Marrow Transplant 1997 20: 1063–1067
O'Driscoll BR, Hasleton PS, Taylor PM et al. Active lung fibrosis up to 17 years after chemotherapy with carmustine (BCNU) in childhood New Engl J Med 1990 323: 378–382
Durant JR, Norgord MJ, Murad TM et al. Pulmonary toxicity associated with bis-chloroethyl nitrosourea (BCNU) Ann Intern Med 1979 90: 191–194
Quabeck K . The lung as a critical organ in marrow transplantation Bone Marrow Transplant 1994 14: S19–S28
Valteau D, Hartmann O, Benhamou E et al. Nonbacterial nonfungal interstitial pneumonitis following autologous bone marrow transplantation in children treated with high dose chemotherapy without TBI Transplantation 1988 45: 737–740
Demirer T, Weaver CH, Buckner CD et al. High dose cyclophosphamide, carmustine and etoposide followed by allogeneic bone marrow transplantation in patients with lymphoid malignancies who had received prior dose limiting radiation therapy J Clin Oncol 1995 13: 596–602
Todd NW, Peters WP, Ost AH et al. Pulmonary drug toxicity in patients with primary breast cancer treated with high dose combination chemotherapy and autologous bone marrow transplantation Am Rev Respir Dis 1993 147: 1264–1270
Lund MB, Kongerud J, Boe J et al . Cardiopulmonary sequelae after treatment for Hodgkin's disease: increased risk in females? Ann Oncol 1996 7: 257–264
Jones RB, Matthes S, Shpall EJ et al. Acute lung injury following treatment with high dose cyclophosphamide, cisplatin, and carmustine: pharmacodynamic evaluation of carmustine J Natl Cancer Inst 1993 85: 640–647
Kalaycioglu M, Kavuru M, Tuason L, Bolwell B . Empiric prednisone therapy for pulmonary toxic reaction after high-dose chemotherapy containing carmustine (BCNU) Chest 1995 107: 482–487
Weiss RB, Poster DS, Penta JS . The nitrosoureas and pulmonary toxicity Cancer Treat Rev 1981 8: 111–125
Aronin PA, Mahaley MS, Rudnick SA et al. Prediction of BCNU pulmonary toxicity in patients with malignant gliomas: assessment of risk factors New Engl J Med 1980 303: 183–188
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Alessandrino, E., Bernasconi, P., Colombo, A. et al. Pulmonary toxicity following carmustine-based preparative regimens and autologous peripheral blood progenitor cell transplantation in hematological malignancies. Bone Marrow Transplant 25, 309–313 (2000). https://doi.org/10.1038/sj.bmt.1702154
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DOI: https://doi.org/10.1038/sj.bmt.1702154
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