[Methotrexate pneumonitis arising during the treatment of non-Hodgkin's lymphomas with the m-BACOD protocol].
We retrospectively studied 32 patients treated with the m-BACOD regimen in a single institution between January 1988 and December 1991. After four to seven courses, four patients presented severe acute pneumonitis (PaO2 < 55 mmHg in room air), with diffuse bilateral interstitial syndrome. Broncho-alveolar lavage displayed increased lymphocyte count (> 45%) with inversion of CD4/CD8 in two cases and no evidence of parasitic, bacterial or viral infection. All patients received methyl-prednisolone (0.5 to 1 mg/kg/d x 1 week) with both complete clinical and radiological recovery within a week. The m-BACOD regimen was continued without bleomycine for four patients and without bleomycine plus methotrexate for two patients, until the completion of eight courses, without recurrence of pneumonitis. Drug-exclusion decisions were made empirically because the exact nature of the pneumonitis was not recognized at the time of diagnostic. Because of the regular administration in the m-BACOD regimen, methotrexate leads to an increased risk of pneumonitis. We concluded that the use of the m-BACOD regimen should henceforth be discontinued.
Renaudier
P
P
CHU Brabois, Vandoeuvre-lès-Nancy, France.
Chabot
F
F
Ferry
R
R
Witz
F
F
Witz
B
B
Guerci
O
O
Polu
J M
JM
Delorme
N
N
Lederlin
P
P
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001761:Bleomycin / Q000009:adverse effects; D003520:Cyclophosphamide / Q000009:adverse effects; D003907:Dexamethasone / Q000009:adverse effects; D004317:Doxorubicin / Q000009:adverse effects; D005260:Female; D006801:Humans; D002955:Leucovorin / Q000009:adverse effects; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D011014:Pneumonia / Q000139:chemically induced* / Q000628:therapy; D014750:Vincristine / Q000009:adverse effects
D000893:Anti-Inflammatory Agents; D001761:Bleomycin; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D002955:Leucovorin; D008775:Methylprednisolone; D008727:Methotrexate