Pulmonary function and complications following chemotherapy and stem cell support in breast cancer

Pulmonary complications are frequent in patients treated with high-dose che motherapy and autologous bone marrow transplantation for breast cancer or o ther solid tumours. This study analyses the development of lung toxicity, changes in respirator y function and occurrence of clinical symptoms in a group of 24 patients (m ean age 46+/-7 yrs) who underwent high-dose sequential chemotherapy (HDS) w ith autologous peripheral blood stem cell (PBSC) support for high risk brea st cancer. Clinical examination, chest radiography and lung function tests were performed before the HDS and 1 and 3 months following transplantation. Only one patient developed acute interstitial pulmonary disease which resol ved after prednisone therapy. No patients developed infectious complication s after transplantation. Baseline respiratory function was normal for most of the parameters. Only lung diffusing capacity of the lung for carbon mono xide (TL,CO) and maximal inspiratory pressure were below the normal range. Following PBSC transplantation only one patient had an altered vital capaci ty while 72.3% of patients had reduced TL,CO values at 1 month and 54.5% at 3 months after transplantation. Maximal expiratory flow at 25% forced vita l capacity, TL,CO and maximal expiratory pres-sure were significantly reduc ed after 1 month but recovered slightly by 3 months, Arterial oxygen tensio n between baseline and both follow-up evaluations declined significantly in patients seropositive for human cytomegalovirus. It is concluded that this high-dose sequential chemotherapy regimen is acce ptably safe since no pulmonary related mortality or respiratory infectious complications were observed, The only lung function alteration induced was an isolated diffusing capacity of the lung for carbon monoxide impairment, clinically negligible and partially recovered within 3 months.