title: Increased incidence of interstitial pneumonia by CHOP combined with rituximab.
abstract: Several authors have reported interstitial pneumonia (IP) during rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy, while others have encountered Pneumocystis jirovecii pneumonia during rituximab-combined bi-weekly CHOP. Herein, we report that 13 of 90 (14%) patients developed IP during R-CHOP therapy, compared with none of 105 patients treated with CHOP alone as a historical control. There were no differences in baseline data between patients undergoing the two therapies. Among R-CHOP-treated patients, serum beta-D-glucan was increased in 8 of 12 (75%) IP patients compared with none of 30 non-IP patients examined. In five IP patients who underwent sputum evaluation, two were positive for P. jirovecii by the polymerase chain reaction and another two were positive for Candida albicans. No other organisms were detected as causative pathogens. Treatment with steroids, sulfamethoxazole-trimethoprim (ST), and antifungals was effective. Our results suggest that R-CHOP raises the incidence of IP, possibly through increasing the susceptibility to P. jirovecii and fungal infection. The need for prophylactic antifungals and ST during R-CHOP should be evaluated by randomized controlled trials.
authors.affiliation: Department of Oncology and Hematology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.|Department of Hematology and Oncology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ennishi
authors.affiliation: Department of Oncology and Hematology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Terui
authors.affiliation: Department of Oncology and Hematology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yokoyama
authors.affiliation: Department of Oncology and Hematology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Mishima
authors.affiliation: Department of Oncology and Hematology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Department of Pathology, The Cancer Institute of the Japanese Foundation of Cancer Research, Tokyo, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Takeuchi
authors.affiliation: Department of Transfusion Medicine, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Ikeda
authors.affiliation: Department of Hematology and Oncology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
authors.forename: Mitsune
authors.initials: M
authors.lastname: Tanimoto
authors.affiliation: Department of Oncology and Hematology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan. khatake@jfcr.or.jp.
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Hatake
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001671:Biochemistry; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007167:Immunotherapy; D017563:Lung Diseases, Interstitial / Q000378:metabolism / Q000473:pathology*; D008223:Lymphoma / Q000188:drug therapy / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D000069283:Rituximab; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone