Pulmonary toxicity following carmustine-based preparative regimens and autologous peripheral blood progenitor cell transplantation in hematological malignancies

Sixty-five patients with hematological malignancies (25 multiple myeloma, 1 8 Hodgkin's disease, 22 non-Hodgkin's lymphomas) who received a carmustine- based regimen followed by autologous PBPC transplantation, were studied ret rospectively to evaluate the incidence of post-transplant non-infective pul monary complications (NIPCs), risk factors predictive of NIPCs, and respons e to steroids. Carmustine (BCNU) given i.v, at a dose of 600 mg/m(2) was co mbined with etoposide and cyclophosphamide in 40 patients (BCV regimen) and with etoposide and melphalan in 25 patients (BEM regimen). Seventeen of 65 patients (26%) had one episode of NIPCs, The median time to NIPCs was 90 d ays (52-289). Factors that increased the risk of developing NIPCs on multiv ariate analysis were female sex (P < 0.001) and BCV regimen (P < 0.05). All patients with NIPCs received prednisone at a dose of 1 mg/kg body weight f or 10 days then tapered by 5 mg every two days; complete response to steroi ds was achieved in 15 of 17 patients; one unresponsive patient died of inte rstitial pneumonia, BCNU given at the dose of 600 mg/m(2) is well tolerated when associated with melphalan and etoposide, In females and in patients r eceiving BCNU with cyclophosphamide, a BCNU dose reduction may be advisable .