Pulmonary Effects of Antineoplastic Therapy

Pulmonary Complications of Malignancies and Blood and Marrow Transplantation

“…The respiratory system is particularly susceptible to drug toxicity during childhood due to ongoing physiological development, its rich vascularity and large contact surface area. As summarised in Table 4, the presentation and pathogenesis of injury varies with specific drugs but is generally hypothesised to arise from several key mechanisms: (1) oxidative injury to endothelium and pneumocytes, (2) cytokine induction and inflammation, (3) proteinolytic destruction, (4) immune dysregulation and/or ( 5) idiosyncrasy [35,[55][56][57].…”

“…Pulmonary-toxic chemotherapies can cause acute pulmonary and pleural reactions such as hypersensitivity pneumonitis, pleural effusions and lung infiltrates. Hypersensitivity reactions are most frequently reported with bleomycin and methotrexate and usually manifest as reversible eosinophilic or desquamative interstitial pneumonitis [48,55,58]. However, the most pertinent and concerning pulmonary complications of chemotherapy are interstitial pneumonitis and permanent fibrosis.…”

“…Management is primarily reactive with cessation of the offending chemotherapy agent and supportive care with bronchodilators, antibiotics, airway clearance and/or supplemental oxygen [2,61]. Limited evidence suggests corticosteroids may relieve hypersensitivity reactions, though steroid withdrawal must be gradual to avoid reactivation [55,61]. Early drug-induced pneumonitis is largely reversible, emphasising the importance of lung function monitoring and prompt diagnosis [55,62].…”

“…Limited evidence suggests corticosteroids may relieve hypersensitivity reactions, though steroid withdrawal must be gradual to avoid reactivation [55,61]. Early drug-induced pneumonitis is largely reversible, emphasising the importance of lung function monitoring and prompt diagnosis [55,62]. However, pulmonary function and radiographic abnormalities often persist into adulthood and are associated with premature lung disease and mortality [2,58,59,62].…”

“…It is the most widely recognised cause of drug-related lung injury, affecting up to 72% of children treated with bleomycin with a 1-2% mortality [58,[61][62][63][64][65][66]. Bleomycin has been reported to cause both acute hypersensitivity reactions and late interstitial pneumonitis and fibrosis within 1 year of treatment [55,67,68]. Vascular toxicities involving intimal fibrosis and pulmonary hypertension have also been observed [73].…”