PULMONARY TOXICITY AFTER GRANULOCYTE-COLONY-STIMULATING FACTOR-COMBINED CHEMOTHERAPY FOR NON-HODGKINS-LYMPHOMA

Sporadic cases have developed pulmonary toxicity after receiving chemo therapy and granulocyte colony-stimulating factor (G-CSF), However, be cause such cases received chemotherapy that alone frequently causes pu lmonary toxicity, the role of G-CSF in this toxicity has been unclear. CHOP therapy (cyclophosphamide, doxorubicin, vincristine and predniso lone) only slightly induces pulmonary toxicity. However, we observed a considerable incidence of this toxicity in non-Hodgkin's lymphoma sub jects receiving CHOP therapy and G-CSF (6 out of 52 subjects, 11.5%). In this cohort, among various characteristics, including the dose and interval of CHOP therapy, only the mean peak leucocyte count (MPLC) wi th each therapy cycle was associated with development of this toxicity (MPLC greater than or equal to 23.0 x 10(9) l(-1), 6 out of 29 cases; MPLC < 23.0 x 10(9) l(-1), 0 out of 23 cases; P= 0.020). These findin gs suggest that the effect of G-CSF is the main determinant of the pul monary toxicity in these cases. Because the toxicity was associated wi th a large MPLC and did not recur in cases readministered G-CSF, an id iosyncratic reaction to G-CSF is unlikely to be the pathogenesis of th is toxicity. Thus, lowering the G-CSF dose seems to be useful in the p revention of this toxicity. In all six cases, the time course of manif estation of the toxicity was the same, and early application of high-d ose corticosteroid led to cure. This knowledge will be helpful in the care of similar cases.