Successful therapy with high-dose steroids and cyclosporine for the treatment of carmustine-mediated lung injury.
The treatment of the pulmonary toxicity induced by carmustine is nowadays based on the use of corticosteroids that generally lead to a rapid resolution of pneumonitis. On the contrary, no therapeutic alternatives are reported for those patients who do not respond to steroids. We describe a case of non-Hodgkin's lymphoma in a patient who developed a severe interstitial pneumonitis after an autologous transplantation including carmustine in the conditioning regimen. He was successfully treated with an association of steroids and cyclosporine A with a rapid improvement of symptoms and a complete resolution of pneumonitis. This is, to our knowledge, the first case of carmustine-induced pneumonitis, resistant to steroids alone, successfully treated with cyclosporine A. This suggests an immunoallergic mechanism in the pathogenesis of the damage, which can be reversed with prompt therapy.
Zappasodi
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Division of Hematology, IRCCS Policlinico San Matteo, 27100 Pavia, Italy. patrizia.zappasodi@libero.it
Vitulo
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P
Volpini
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E
Castagnola
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Nascimbene
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Corso
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A
D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000494:pharmacology*; D002330:Carmustine / Q000494:pharmacology*; D016572:Cyclosporine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000628:therapy; D008775:Methylprednisolone / Q000008:administration & dosage*; D012128:Respiratory Distress Syndrome / Q000139:chemically induced / Q000188:drug therapy*
D018906:Antineoplastic Agents, Alkylating; D016572:Cyclosporine; D002330:Carmustine; D008775:Methylprednisolone