Nonspecific Interstitial Pneumonitis after Bortezomib and Thalidomide Treatment in a Multiple Myeloma Patient

Kang, Wonseok; Kim, Jin Seok; Cho, Sang-Ho; Kim, Sung Kyu; Chang, Joon; Park, Moo Suk

doi:10.3349/ymj.2010.51.3.448

Cited by 15 publications

(7 citation statements)

References 7 publications

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“…In the present study, 70% of the patients received rituximab with or without bortezomib, which might have contributed to the higher frequency because both agents have been reported to be associated with pneumonitis in some previous reports [7,[17][18][19][20][21][22]. Also, rituximab has recently been used to treat interstitial lung diseases [23,24].…”

Section: Discussionmentioning

confidence: 64%

Drug-Related Pneumonitis During Mammalian Target of Rapamycin Inhibitor Therapy: Radiographic Pattern-Based Approach in Waldenström Macroglobulinemia as a Paradigm

et al. 2015

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Background. This study determined the frequency of drug‐related pneumonitis during mammalian target of rapamycin (mTOR) inhibitor therapy in Waldenström macroglobulinemia patients and investigated the imaging characteristics and radiographic patterns of pneumonitis. Materials and Methods. A total of 40 patients (23 men, 17 women; 43–84 years old) with Waldenström macroglobulinemia treated in 2 trials of the mTOR inhibitor everolimus were retrospectively studied. Chest computed tomography (CT) scans during therapy were reviewed for abnormalities suspicious for drug‐related pneumonitis by the consensus of three radiologists, evaluating the extent, distributions, and specific findings. The radiographic patterns of pneumonitis were classified using the American Thoracic Society/European Respiratory Society classification of interstitial pneumonia. Results. Drug‐related pneumonitis was noted in 23 patients (58%). The median time from the initiation of therapy to the onset of pneumonitis was 5.7 months. Lower lungs were involved in all 23 patients, with a higher extent than in the other zones (p < .001). The distribution was peripheral and lower in 11 patients (48%) and mixed and multifocal in 10 (44%). The findings were bilateral in 20 patients (87%). Ground glass opacities (GGOs) and reticular opacities were present in all 23 patients, with consolidation in 12, traction bronchiectasis in 2, and centrilobular nodularity in 1. The pattern of pneumonitis was classified as cryptogenic organizing pneumonia (COP) in 16 (70%) and nonspecific interstitial pneumonia (NSIP) in 7 (30%), with overlapping features of COP and NSIP in 7 patients. Conclusion. Drug‐related pneumonitis was noted on CT in 58% of Waldenström macroglobulinemia patients treated with mTOR inhibitor therapy. Most common findings were bilateral GGOs and reticular opacities, with or without consolidation, in peripheral and lower lungs, demonstrating COP and NSIP patterns. Implications for Practice: The present study has demonstrated that drug‐related pneumonitis during mammalian target of rapamycin (mTOR) inhibitor therapy is highly frequent, occurring in 58% of patients with Waldenström macroglobulinemia. The radiographic patterns of pneumonitis demonstrated cryptogenic organizing pneumonia and nonspecific interstitial pneumonia patterns, with overlapping features in 30% of the patients. The present study describes an initial attempt of a radiographic pattern‐based approach to drug‐related pneumonitis in the era of molecular targeting therapy, with a cohort of patients with Waldenström macroglobulinemia receiving mTOR inhibitor therapy as a paradigm, which might contribute to further understanding and in‐depth interpretation of lung toxicity during novel cancer therapy.

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Section: Discussionmentioning

confidence: 64%

Drug-Related Pneumonitis During Mammalian Target of Rapamycin Inhibitor Therapy: Radiographic Pattern-Based Approach in Waldenström Macroglobulinemia as a Paradigm

et al. 2015

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“…Since this time, 16 cases have been described as MM with bortezomib-induced pulmonary complications (6,(8)(9)(10)(11)(12)(13)(14)(15). The patient in the present study also developed severe pulmonary complications during bortezomib treatment.…”

Section: Discussionmentioning

confidence: 52%

Bortezomib-induced severe pulmonary complications in multiple myeloma: A case report and literature review

Chen

et al. 2016

Oncology Letters

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Abstract. The proteasome inhibitor bortezomib is indicated for use in the treatment of multiple myeloma (MM) patients. The most common side effects are neurological and gastrointestinal, while severe pulmonary complications are rarely described. The present study reports the case of a 62-year-old man with immunoglobulin (Ig)G-type MM who was treated with bortezomib, thalidomide and dexamethasone. Subsequent to the administration of chemotherapy, the patient developed an acute respiratory distress syndrome. High-resolution computed tomography of the chest showed bilateral diffuse alveolar infiltrations and multiple subpleural lesions. A diagnosis of bortezomib-induced severe pulmonary complications was formed. Systemic corticosteroid therapy led to a rapid improvement in clinical conditions and radiological findings. In addition, the present study reviewed the characteristics, including medical history, clinical manifestations, treatment strategies and outcomes, of all 16 MM patients with bortezomib-induced severe pulmonary complications reported previously in Pubmed. It was indicated that patients who were male, of IgG type, with a relapse status and a previous history of auto-PBSCT had a higher possibility of developing bortezomib-induced severe pulmonary complications. Additionally, a relatively low dose rather than a high dose of corticosteroids could obtain a better outcome.

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“…BAL fluid in one reported case of NSIP showed lowered CD4/CD8 ratio. This type of pneumonia has been reported as complication of therapy with thalidomide and bortezomib [82,83]. On the other hand, agents that can cause fibrosis include nitrosourea compounds [35], bleomycin [84], busulfan [85], chlorambucil [86], cyclophosphamide [87], methotrexate [41], mitomycin C [88] and paclitaxel [89].…”

Section: Usual Interstitial Pneumonia and Non-specific Interstitial Pnementioning

confidence: 99%

Antineoplastic therapy-induced pulmonary toxicity

Sadowska¹,

Specenier²,

Germonpré

et al. 2013

Expert Review of Anticancer Therapy

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Pulmonary complications of antineoplastic therapy are common and are an important cause of respiratory morbidity. The pulmonary toxicity should be taken into account in every patient with respiratory problems who is or has been treated with antineoplastic agents. The diagnosis of drug-induced pulmonary toxicity is complex and should be based on the medical history, clinical, radiological and pathological findings. None of them are specific but they can guide the diagnostic process. The treatment of pulmonary abnormalities caused by chemotherapy is mostly supportive and based on cessation of the causative agent. However, the therapeutic options in oncology setting are usually limited thus the decision about changing the treatment should be taken with caution.

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Nonspecific Interstitial Pneumonitis after Bortezomib and Thalidomide Treatment in a Multiple Myeloma Patient

Cited by 15 publications

References 7 publications

Drug-Related Pneumonitis During Mammalian Target of Rapamycin Inhibitor Therapy: Radiographic Pattern-Based Approach in Waldenström Macroglobulinemia as a Paradigm

Drug-Related Pneumonitis During Mammalian Target of Rapamycin Inhibitor Therapy: Radiographic Pattern-Based Approach in Waldenström Macroglobulinemia as a Paradigm

Bortezomib-induced severe pulmonary complications in multiple myeloma: A case report and literature review

Antineoplastic therapy-induced pulmonary toxicity

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