Pulmonary Toxicity of Chemotherapy

OVERVIEW

General principles

• rule out pulmonary oedema from congestive cardiac failure
• rule out lung infection (normal and opportunistic organisms)
• rule out lung infiltration by cancer cells
• determine time from chemotherapy to onset of respiratory symptoms -> compare with literature -> re-challenge
• check clinical manifestations and laboratory test abnormalities consistent with lung toxicity induced by suspected drug
• determine whether symptoms resolve after the drug is stopped and steroids are given

SPECIFIC AGENTS

Bleomycin

• 3-40% of patients
• pneumonitis with diffuse pulmonary infiltrates and fibrosis
• risk factors:
  -> higher cumulative bleomycin dose
  -> renal failure
  -> > 70 years
  -> smoker
  -> radiation to chest
  -> high O2 concentrations
  -> G-CSF
  -> administration of other chemotherapeutic with lung toxicity

Methotrexate

• acute/subacute pneumonitis simulating infection

ATRA Lung

• All Trans-Retinoic Acid – helps differentiate APL blasts and improve remission and relapse rates
• occurs day 2-21 days into treatment
• features: fever, leukocytosis, SOB, weight gain, pleural effusions, infiltrates

Other

• fludarabine
• gemcitabine
• cytarabine
• cyclophosphamide