Respiratory
Chemotherapy Related Toxicity
Lung disease after chemotherapy may be obstructive, restrictive, interstitial or mixed3.
Most long term toxicity to the lungs is the result of interstitial lung disease.
Chemotherapy induced lung fibrosis in children cancer survivors:
- CCSS study indicated that the rate of first occurrence was highest during treatment36
- may remain asymptomatic for many years or
- can be symptomatic at any time
Chemotherapy agents associated with pulmonary toxicity include:
- Bleomycin
- Mitomycin-C
- Alkylating agents:
- BCNU
- Busulfan (BU)
- Cyclophosphamide (CY)
- Melphalan
- Antimetabolites:
- 6-mercaptopurine
- azathioprine
- methotrexate
- cytosine arabinoside
- Procarbazine
- VM-26
Generally pulmonary toxicity associated with chemotherapy is infrequent and sporadic
Table: Common used chemotherapy agents associated with pulmonary damage
Agent |
Toxicity |
Risk Factor |
Bleomycin |
Interstitial Pneumonitis22
Pulmonary Fibrosis22
Acute respiratory distress syndrome22 (very rare) |
Higher Cumulative dose22
Greatest risk Factors:
|
Alkylating agents (Busulfan, Carmustine, Lomustine) |
Pulmonary Fibrosis22 |
The risk is highest with:
|
Cytosine arabinoside |
Non-cardiogenic pulmonary edema3 |
|
Methotrexate |
Interstitial pneumonitis
Non-cardiogenic pulmonary edema3
Pulmonary fibrosis3 Bronchospasm |
|
