title: Risk factors for development of pneumonitis after high-dose chemotherapy with cyclophosphamide, BCNU and etoposide followed by autologous stem cell transplant.
abstract: Pneumonitis is a complication of high-dose chemotherapy and autologous stem cell transplant (HDC-ASCT) regimens containing BCNU. Our goal was to define the incidence and risk factors for pneumonitis in patients with lymphoma receiving a uniform conditioning regimen in the modern era. We studied 222 patients who received HDC-ASCT using cyclophosphamide, BCNU and VP-16 (CBV). Pneumonitis incidence was 22%, with 19% receiving systemic corticosteroid treatment and 8% requiring inpatient hospitalization for pneumonitis. Three patients died secondary to pneumonitis-related complications. The following variables were independently associated with pneumonitis: prior mediastinal radiation (odds ratio [OR] 6.5, 95% confidence interval [CI] 2.3-18.9, p = 0.0005), total BCNU dose above 1000 mg (OR 3.4, 95% CI 1.3-8.7, p = 0.012) and age less than 54 (OR 3.0, 95% CI 1.4-6.5, p = 0.0037). Increased vigilance for symptoms of pneumonitis is warranted for patients with prior mediastinal radiation and for younger patients, and dose reduction may be considered for patients who would receive greater than 1000 mg of BCNU.
authors: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
authors: Andrew A
authors: AA
authors: Lane
authors: Philippe
authors: P
authors: Armand
authors: Yang
authors: Y
authors: Feng
authors: Donna S
authors: DS
authors: Neuberg
authors: Jeremy S
authors: JS
authors: Abramson
authors: Jennifer R
authors: JR
authors: Brown
authors: David C
authors: DC
authors: Fisher
authors: Ann S
authors: AS
authors: LaCasce
authors: Eric D
authors: ED
authors: Jacobsen
authors: Steven L
authors: SL
authors: McAfee
authors: Thomas R
authors: TR
authors: Spitzer
authors: Arnold S
authors: AS
authors: Freedman
authors: Yi-Bin
authors: YB
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D002330:Carmustine / Q000008:administration & dosage / Q000009:adverse effects*; D003131:Combined Modality Therapy / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008482:Mediastinum / Q000528:radiation effects; D008875:Middle Aged; D011014:Pneumonia / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D011839:Radiation, Ionizing; D012189:Retrospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D019172:Transplantation Conditioning / Q000009:adverse effects; D014182:Transplantation, Autologous; D055815:Young Adult
chemical_list: D005047:Etoposide; D003520:Cyclophosphamide; D002330:Carmustine