Antineoplastics
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Reactions 880 - 1 Dec 2001 Antineoplastics Pneumonitis: 3 case reports Pneumonitis developed in 3 patients with multiple myeloma following maintenance antineoplastic therapy. All 3 patients had been treated with carmustine and melphalan 6–20 months earlier, and they had all undergone autologous peripheral blood stem cell transplantation. They all received antineoplastic therapy comprising cyclophosphamide 300 mg/m 2 by continuous IV infusion for 4 days, oral dexamethasone 40 mg/day for 4 days, etoposide 30 mg/m 2 by continuous IV infusion for 4 days and cisplatin 15 mg/m 2 by continuous infusion for 4 days (CDEP) for courses 1 and 3; courses 2 and 4 comprised dexamethasone, paclitaxel and cisplatin. The first patient was a 56-year-old man with a history of fungal pneumonia. He presented with dyspnoea, nonproductive cough and severe hypoxaemia approximately 4 weeks after receiving CDEP. Antineoplastic-induced pneumonitis was diagnosed. He was treated with a short course of oral methylprednisolone. However, rapid tapering of methylprednisolone resulted in a recurrence of his symptoms, so corticosteroid therapy was reinstated and slowly tapered. His symptoms resolved, and no further reactivation of fungal pneumonia occurred. The second patient was a 53-year-old woman who had developed pneumonia with extensive bilateral pulmonary infiltrates after receiving her first instance of treatment with CDEP. At that time, maintenance antineoplastic therapy was withheld. A second autologous peripheral blood stem cell transplant was required approximately 11 months after she first received CDEP. Treatment with CDEP was reinstated 3 months later. Approximately 2 months after restarting CDEP, she presented with fever, malaise, nonproductive cough, dyspnoea and mild hypoxaemia. A chest CT scan showed a diffuse ground glass pattern. She received methylprednisolone, tapered over 3 weeks, to treat antineoplastic-induced pneumonitis. Her symptoms resolved rapidly, with no subsequent relapse of fungal pneumonia. The third patient was a 65-year-old woman with proven fungal pneumonia prior to receiving CDEP. She presented with similar symptoms to those of the other 2 patients approximately 3 months after she received CDEP. The findings of a transbronchial biopsy were consistent with antineoplastic- induced pneumonitis. She was treated with methylprednisolone, tapered over 3 weeks, and her symptoms disappeared rapidly and did not return. Author comment: ‘Non-infective pulmonary toxicity syndrome may rarely complicate the course of a commonly used chemotherapy regimen, such as CDEP, possibly in association with previous, treated, fungal pneumonia. Recognition of the syndrome, timely establishment of diagnosis and prompt treatment with steroids are essential for a favorable clinical outcome.’ Fassas A, et al. Pulmonary toxicity syndrome following CDEP (cyclophosphamide, dexamethasone, etoposide, cisplatin) chemotherapy. Bone Marrow Transplantation 28: 399-403, No. 4, Aug 2001 - USA 800880431 1 Reactions 1 Dec 2001 No. 880 0114-9954/10/0880-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 880 - 1 Dec 2001
Antineoplastics
Pneumonitis: 3 case reportsPneumonitis developed in 3 patients with multiple myeloma
following maintenance antineoplastic therapy. All 3 patientshad been treated with carmustine and melphalan 6–20 monthsearlier, and they had all undergone autologous peripheralblood stem cell transplantation. They all receivedantineoplastic therapy comprising cyclophosphamide 300mg/m2 by continuous IV infusion for 4 days, oraldexamethasone 40 mg/day for 4 days, etoposide 30 mg/m2 bycontinuous IV infusion for 4 days and cisplatin 15 mg/m2 bycontinuous infusion for 4 days (CDEP) for courses 1 and 3;courses 2 and 4 comprised dexamethasone, paclitaxel andcisplatin.
The first patient was a 56-year-old man with a history offungal pneumonia. He presented with dyspnoea,nonproductive cough and severe hypoxaemia approximately 4weeks after receiving CDEP. Antineoplastic-inducedpneumonitis was diagnosed. He was treated with a shortcourse of oral methylprednisolone. However, rapid tapering ofmethylprednisolone resulted in a recurrence of his symptoms,so corticosteroid therapy was reinstated and slowly tapered.His symptoms resolved, and no further reactivation of fungalpneumonia occurred.
The second patient was a 53-year-old woman who haddeveloped pneumonia with extensive bilateral pulmonaryinfiltrates after receiving her first instance of treatment withCDEP. At that time, maintenance antineoplastic therapy waswithheld. A second autologous peripheral blood stem celltransplant was required approximately 11 months after shefirst received CDEP. Treatment with CDEP was reinstated 3months later. Approximately 2 months after restarting CDEP,she presented with fever, malaise, nonproductive cough,dyspnoea and mild hypoxaemia. A chest CT scan showed adiffuse ground glass pattern. She receivedmethylprednisolone, tapered over 3 weeks, to treatantineoplastic-induced pneumonitis. Her symptoms resolvedrapidly, with no subsequent relapse of fungal pneumonia.
The third patient was a 65-year-old woman with provenfungal pneumonia prior to receiving CDEP. She presented withsimilar symptoms to those of the other 2 patientsapproximately 3 months after she received CDEP. The findingsof a transbronchial biopsy were consistent with antineoplastic-induced pneumonitis. She was treated withmethylprednisolone, tapered over 3 weeks, and her symptomsdisappeared rapidly and did not return.
Author comment: ‘Non-infective pulmonary toxicitysyndrome may rarely complicate the course of a commonlyused chemotherapy regimen, such as CDEP, possibly inassociation with previous, treated, fungal pneumonia.Recognition of the syndrome, timely establishment of diagnosisand prompt treatment with steroids are essential for a favorableclinical outcome.’Fassas A, et al. Pulmonary toxicity syndrome following CDEP (cyclophosphamide,dexamethasone, etoposide, cisplatin) chemotherapy. Bone Marrow Transplantation28: 399-403, No. 4, Aug 2001 - USA 800880431
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Reactions 1 Dec 2001 No. 8800114-9954/10/0880-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
