PMID- 9476874
OWN - NLM
STAT- MEDLINE
DCOM- 19980312
LR  - 20191211
IS  - 1073-449X (Print)
IS  - 1073-449X (Linking)
VI  - 157
IP  - 2
DP  - 1998 Feb
TI  - Delayed pulmonary toxicity syndrome following high-dose chemotherapy and bone 
      marrow transplantation for breast cancer.
PG  - 565-73
AB  - We have intensely followed 45 consecutive women who underwent high-dose 
      chemotherapy (cyclophosphamide/cisplatin/BCNU) and autologous bone marrow 
      transplant (HDC/ABMT) for primary breast cancer with pulmonary function testing 
      and computed tomography at regular intervals up to 126 wk (median follow-up, 72 
      wk). Our results show a high incidence of interstitial pneumonitis requiring 
      steroids (64%), but no deaths due to pulmonary toxicity. The DL(CO) reaches a 
      nadir of 58.2 +/- SEM 3.4 (expressed as a percent of baseline value) 15-18 wk 
      following HDC/ABMT, and marginally improves with time. To a much lesser extent, 
      vital capacity is reduced with a parallel drop in FEV1, suggesting mild 
      restrictive changes without significant obstruction. Patients who develop 
      pulmonary symptoms of cough or dyspnea have a corresponding significantly greater 
      and earlier decline in DL(CO). Chest computed tomography was neither sensitive 
      nor specific for diagnosing pulmonary toxicity. For patients who received 
      steroids for pulmonary toxicity, there was a subsequent improvement in DL(CO) of 
      17.1% (p = 0.0001). Because our patients do not fit with the recent definition of 
      idiopathic pulmonary syndrome (IPS), we propose the term delayed pulmonary 
      toxicity syndrome (DPTS) to better describe the milder form of lung toxicity seen 
      in our patient population. We were unable to correlate the severity of DPTS with 
      age, tobacco use, baseline pulmonary function, or systemic exposure to BCNU, 
      cyclophosphamide, or cisplatin. These data suggest that factor(s) other than, or 
      in addition to, chemotherapy systemic exposure can contribute to DPTS. 
      Furthermore, early identification and institution of systemic corticosteroids may 
      improve lung function.
FAU - Wilczynski, S W
AU  - Wilczynski SW
AD  - Department of Medicine, Duke University Medical Center, Durham, North Carolina 
      27710, USA.
FAU - Erasmus, J J
AU  - Erasmus JJ
FAU - Petros, W P
AU  - Petros WP
FAU - Vredenburgh, J J
AU  - Vredenburgh JJ
FAU - Folz, R J
AU  - Folz RJ
LA  - eng
GR  - HL07538/HL/NHLBI NIH HHS/United States
GR  - HL55166/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Am J Respir Crit Care Med
JT  - American journal of respiratory and critical care medicine
JID - 9421642
RN  - 0 (Steroids)
SB  - IM
MH  - Adult
MH  - Antineoplastic Combined Chemotherapy Protocols/administration & 
      dosage/*therapeutic use
MH  - *Bone Marrow Transplantation
MH  - Breast Neoplasms/physiopathology/radiotherapy/*therapy
MH  - Combined Modality Therapy/adverse effects
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Humans
MH  - Infections/etiology
MH  - Lung/*drug effects/physiopathology/radiation effects
MH  - Middle Aged
MH  - Radiography, Thoracic
MH  - Respiratory Function Tests
MH  - Retrospective Studies
MH  - Steroids/therapeutic use
MH  - Tomography, X-Ray Computed
EDAT- 1998/02/26 00:00
MHDA- 1998/02/26 00:01
CRDT- 1998/02/26 00:00
PHST- 1998/02/26 00:00 [pubmed]
PHST- 1998/02/26 00:01 [medline]
PHST- 1998/02/26 00:00 [entrez]
AID - 10.1164/ajrccm.157.2.9705072 [doi]
PST - ppublish
SO  - Am J Respir Crit Care Med. 1998 Feb;157(2):565-73. doi: 
      10.1164/ajrccm.157.2.9705072.