. Oxidative stress and inflammation contribute to lung toxicity after a common breast cancer chemotherapy regimen. Am J Physiol Lung Cell Mol Physiol 283: L336-L345, 2002. First published March 29, 2002 10.1152/ ajplung.00012.2002-Delayed pulmonary toxicity syndrome after high-dose chemotherapy (HDC) and autologous hematopoietic support occurs in up to 64% of women with advanced-stage breast cancer. Using a similar, but nonmyeloablative, HDC treatment regimen in mice, we found both immediate and persistent lung injury, coincident with marked decreases in lung tissue glutathione reductase activity and accompanied by increases in lung oxidized glutathione, bronchoalveolar lavage (BAL) lipid peroxidation, and BAL total cell counts. Most interestingly, at 6 wk, BAL total cell counts had increased fourfold, with lymphocyte cell counts increasing Ͼ11-fold. A single supplemental dose of glutathione prevented early lung injury at 48 h but showed no lung-protective effects at 6 wk, whereas single doses of other thiol-sparing agents (Ethyol and glutathione monoethyl ester) showed no benefit. These data suggest that this HDC regimen results in acute and persistent lung toxicity, induced in part by oxidative stress, that culminates with an acute lung cellular inflammatory response. Continuous glutathione supplementation and/or attenuation of the delayed pulmonary inflammatory response may prove beneficial in preventing lung toxicity after the use of these chemotherapeutic agents. delayed pulmonary toxicity syndrome; high-dose chemotherapy; lung injury; glutathione BREAST CANCER is the most common type of cancer among women in the United States and is also well known for its high frequency of recurrence. A high-dose chemotherapy (HDC) regimen utilizing cyclophosphamide, cisplatin, and carmustine [1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU)] followed by autologous hematopoietic stem cell support has been developed to overcome the recurrence of cancer in these patients (31). Unfortunately, associated with this regimen is a high incidence (39-64%) of pulmonary drug toxicity (40,44). Patients who develop pulmonary drug toxicity frequently manifest symptoms of dyspnea, dry cough, fever, and hypoxemia, which, if left untreated, can be associated with significant mortality and morbidity (31). We have coined the term delayed pulmonary toxicity syndrome (DPTS) to differentiate this late-onset lung toxicity associated with this specific HDC regimen (44). It should be worth emphasizing that DPTS was described in patients undergoing autologous transplant, as contrasted to allogeneic transplant, in which additional factors, such as graft-vs.-host disease and complications due to the immunotherapy regimen, may come into play (16). Whether the pathogenesis of DPTS is part of the spectrum of idiopathic pneumonia syndrome (10) or is a separate entity remains to be determined.All three drugs used for the HDC regimen are known to be cytotoxic to the lung at high doses; however, the mechanism by which these drugs cause lung damage either indi...