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Pulmonary toxicity of induction chemotherapy prior to standard or high-dose chemotherapy with autologous hematopoietic support.

Publication ,  Journal Article
Bhalla, KS; Wilczynski, SW; Abushamaa, AM; Petros, WP; McDonald, CS; Loftis, JS; Chao, NJ; Vredenburgh, JJ; Folz, RJ
Published in: Am J Respir Crit Care Med
January 2000

We closely followed the pulmonary function of 150 consecutive high-risk breast cancer patients who underwent standard induction CAF (cyclophosphamide, doxorubicin, 5-fluorouracil) chemotherapy, followed by randomization to either standard-dose CPB (cyclophosphamide, cisplatin, bischloroethylnitrosourea [BCNU]) chemotherapy (SDC) or to high-dose CPB chemotherapy (HDC) with autologous bone marrow transplantation (ABMT) and peripheral blood progenitor cell support (PBPCS). Previously, we have described a delayed pulmonary toxicity syndrome (DPTS) which characterizes the pulmonary dysfunction after HDC and ABMT in this patient population. However, little is known concerning the role induction chemotherapy plays in its development. We found that after three cycles of induction CAF, the mean diffusing capacity of the lungs for carbon monoxide (DL(CO)) significantly decreased by 12.6%. Additionally, in patients receiving HDC, the mean DL(CO) further decreased to a nadir of 55.2 +/- 14.1% which was significantly lower than those receiving SDC (nadir: 80.7 +/- 12.3%). DPTS occurred in 72% of patients receiving HDC as compared with only 4% of patients receiving SDC. All individuals diagnosed with DPTS were treated with prednisone and the 2-yr follow-up of pulmonary function revealed a gradual improvement in mean DL(CO) such that there were no differences between HDC and SDC groups at the end of the study. No mortality was attributable to pulmonary toxicity in either group. After induction chemotherapy, but before HDC, bronchoalveolar lavage (BAL) demonstrated significant elevations in interleukin-6 (IL-6), IL-8, neutrophils, and lymphocytes. We conclude that induction CAF produces asymptomatic pulmonary dysfunction and inflammation which may prime the lungs for further injury by HDC and predispose to the development of DPTS. Fortunately, in this specific ABMT patient population, the early and judicious use of prednisone appears to improve pulmonary function in patients who develop DPTS.

Duke Scholars

Published In

Am J Respir Crit Care Med

DOI

ISSN

1073-449X

Publication Date

January 2000

Volume

161

Issue

1

Start / End Page

17 / 25

Location

United States

Related Subject Headings

  • Transplantation, Autologous
  • Retrospective Studies
  • Respiratory System
  • Respiratory Function Tests
  • Respiratory Distress Syndrome
  • Receptors, Tumor Necrosis Factor, Type I
  • Receptors, Tumor Necrosis Factor
  • Prednisone
  • Neutrophils
  • Lymphocytes
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Bhalla, K. S., Wilczynski, S. W., Abushamaa, A. M., Petros, W. P., McDonald, C. S., Loftis, J. S., … Folz, R. J. (2000). Pulmonary toxicity of induction chemotherapy prior to standard or high-dose chemotherapy with autologous hematopoietic support. Am J Respir Crit Care Med, 161(1), 17–25. https://doi.org/10.1164/ajrccm.161.1.9903059
Bhalla, K. S., S. W. Wilczynski, A. M. Abushamaa, W. P. Petros, C. S. McDonald, J. S. Loftis, N. J. Chao, J. J. Vredenburgh, and R. J. Folz. “Pulmonary toxicity of induction chemotherapy prior to standard or high-dose chemotherapy with autologous hematopoietic support.Am J Respir Crit Care Med 161, no. 1 (January 2000): 17–25. https://doi.org/10.1164/ajrccm.161.1.9903059.
Bhalla KS, Wilczynski SW, Abushamaa AM, Petros WP, McDonald CS, Loftis JS, et al. Pulmonary toxicity of induction chemotherapy prior to standard or high-dose chemotherapy with autologous hematopoietic support. Am J Respir Crit Care Med. 2000 Jan;161(1):17–25.
Bhalla, K. S., et al. “Pulmonary toxicity of induction chemotherapy prior to standard or high-dose chemotherapy with autologous hematopoietic support.Am J Respir Crit Care Med, vol. 161, no. 1, Jan. 2000, pp. 17–25. Pubmed, doi:10.1164/ajrccm.161.1.9903059.
Bhalla KS, Wilczynski SW, Abushamaa AM, Petros WP, McDonald CS, Loftis JS, Chao NJ, Vredenburgh JJ, Folz RJ. Pulmonary toxicity of induction chemotherapy prior to standard or high-dose chemotherapy with autologous hematopoietic support. Am J Respir Crit Care Med. 2000 Jan;161(1):17–25.

Published In

Am J Respir Crit Care Med

DOI

ISSN

1073-449X

Publication Date

January 2000

Volume

161

Issue

1

Start / End Page

17 / 25

Location

United States

Related Subject Headings

  • Transplantation, Autologous
  • Retrospective Studies
  • Respiratory System
  • Respiratory Function Tests
  • Respiratory Distress Syndrome
  • Receptors, Tumor Necrosis Factor, Type I
  • Receptors, Tumor Necrosis Factor
  • Prednisone
  • Neutrophils
  • Lymphocytes