Early-Onset Diagnosis of Lung Toxicity Caused by Cyclophosphamide, Melphalan and Procarbazine Therapy

Lung function studis were performed in 33 patients with lymphomyeloproliferative diseases (25 cases of multiple myeloma and 8 cases of Hodgkin's disease) who received cyclophosphamide, procarbazine, and melphalan therapy. Lung function was investigated by spirometric tests, indicative tests of small airways disease, and diffusing capacity of the lung for carbon monoxide (DUCO). Indicative tests of small airways disease and other lung function tests such as forced expiratory volume in 1 second (FEY,), vital capacity (VC), total lung capacity (TLC) etc. were markedly improved in 18 patients (55%), whereas 24 patients (73%) showed a decreased diffusing capacity of the lung for carbon monoxide. Furthermore, most of the patients (77% – 83%) showed contemporaneous involvement of spirometric tests and DUCO. The DUCO was also found more constantly impaired than other function tests because it had decreased with and without other spirometric tests. Impaired lung function tests were found to be related to a cumulative dose of antineoplastic drugs. The absence of increased lung toxicity was found to be related to several drugs administered in combination. In view of the absence of previous bronchopathies, lung involvement signs in multiple myeloma (25, 26) or lymphoma, and concomitant bronchopneumonias, the impaired functional tests could be ascibed to drug-induced lung toxicity. In the absence of clinical symptoms, roentgenographic and pathologic features, impaired lung function tests may play a role as early-onset signs of drug-induced lung toxicity.