Pulmonary disease with chlorambucil therapy

Abstract

A 73-year-old female developed pulmonary disease during treatment with chlorambucil for polycythemia vera. Cough and dyspnea were prominent symptoms. A chest roentgenogram revealed interstitial fibrosis. The diffusing capacity was markedly reduced. Pathologic findings included alveolar lining cell dysplasia, interstitial round cell infiltrates and interstitial fibrosis. Resolution of the pulmonary symptoms and partial clearing of the fibrosis on chest roentgenogram followed discontinuation of the chlorambucil and institution of steroid treatment. Chlorambucil may cause pulmonary fibrosis similar to busulfan and cyclophosphamide and this may be a potential complication of all alkylating agents.

Respiratory symptoms, lung function tests, airway responsiveness, and bronchoalveolar lymphocyte subsets in B-Chronic lymphocytic leukemia

“…A high percentage of alveolar CD8lymphocytes were found in two patients who had been treated with chlorambucil, but also in four patients who had never received any treatment for B-CLL. The probability oflung toxicity during chlorambucil therapy is generally considered to be low [22], even if sporadic cases have been reported [9].…”

Chlorambucil-induced pulmonary disease: a case report and review of the literature

“…The overall prognosis is poor, with a mortality of 52.6% (Table 1) [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. The cumulative dose of chlorambucil ranges from 540 mg to 8340 mg, with most patients receiving more than 2000 mg.…”

“…Although the pulmonary toxicity of busulfan and cyclophosphamide, two other alkylating agents, is well known, only 18 cases of chlorambucil-induced lung disease have been reported in the literature [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. The following case report illustrates the difficulty in making the diagnosis because of the rarity of the condition and emphasizes the importance of early recognition because of the high mortality.…”

Pulmonary Toxicity of Cytotoxic and Immunosuppressive Agents: A Review

“…Desquamation, proliferation, and metaplasia of the alveolar epithelium, which are common features of desquamative interstitial pneumonitis and usual interstitial pneumonitis, are the most striking histopathological effects of alkylating agents (47)(48)(49)(50), nitrosoureas (5 1-53), and antitumor antibiotics (54,55) according to lung biopsy and autopsy. However, fibrinous exudation, hyaline membranes, and interstitial fibrosis occur in most cases, and are diagnostic of usual interstitial pneumonitis (46).…”