Incidence, clinical characteristics, and outcome of interstitial pneumonia in patients with lymphoma

Wei Ping Liu,Ning Ding,Yu Qin Song,Ling Yan Ping,Xiao Pei Wang,Li Juan Deng,Wen Zheng,Mei Feng Tu,Ning Jing Lin,Zhi Tao Ying,Chen Zhang,Jun Zhu,Xiao Gan Wang,Yan Xie

doi:10.1007/s00277-017-3157-9

Wei Ping Liu, Ning Ding + Show 12 more

Open Access

https://doi.org/10.1007/s00277-017-3157-9

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Abstract

Interstitial pneumonia (IP) is a lethal complication in lymphoma patients undergoing chemotherapy. A total of 2212 consecutive patients diagnosed with lymphoma between 2009 and 2014 were enrolled in the present study. IP was defined as diffuse pulmonary interstitial infiltrate found on computed tomography scans. IP was observed in 106 patients. Of these, 23 patients were excluded from the study. Finally, 83 patients with IP were included in this study. The incidence of IP was 3.9% (7/287) in Hodgkin lymphoma and 2.4% (76/1925) in non-Hodgkin lymphoma (P = 0.210). The median number of chemotherapy cycles before IP was 3. The median time from the cessation of chemotherapy to IP was 17 days. Eighty-two (98.8%) patients recovered after the treatment with glucocorticoids. Sixty-six (79.5%) patients had a delay in chemotherapy, and 14 (16.9%) patients had premature termination of chemotherapy. Sixty-nine patients were re-treated with chemotherapy after remission from IP, of which 22 (31.9%) experienced IP recurrence. The incidence of IP recurrence was significantly higher in patients re-treated with a similar regimen than in those re-treated with an alternative regimen (65.4 vs. 11.6%, P < 0.001). In a multivariate Cox regression analysis, B symptoms and a history of drug allergies were identified as risk factors for IP. In conclusion, IP is a life-threatening complication in lymphoma patients. Glucocorticoid therapy with continuous monitoring of chest radiographic changes may be a favourable strategy for treating IP. However, IP may recur, especially in patients re-treated with a similar chemotherapy regimen.

Highlights

Interstitial pneumonia (IP) is a heterogeneous disease that includes multiple diffuse parenchymal lung disorders [1, 2]
In patients with non-Hodgkin lymphoma, the incidence of IP was higher in those treated with the R-CHOP regimen than in those treated with the CHOP regimen (P = 0.011)
In patients with Hodgkin lymphoma, the incidence of IP was higher in those treated with the BEACOPP regimen than in those treated with the ABVD regimen (P < 0.001)

Summary

Introduction

Interstitial pneumonia (IP) is a heterogeneous disease that includes multiple diffuse parenchymal lung disorders [1, 2]. Several studies have reported IP in lymphoma patients undergoing chemotherapy with or without rituximab [3, 4]. IP may result in dyspnoea, respiratory failure, and death. Patients who experience IP have more treatment delays and more frequent premature termination of chemotherapy. Overall survival (OS) may be reduced in patients who have recovered from IP. Treatment of IP is challenging because of its protean, multifaceted nature [5]. The incidence of IP recurrence in patients with lymphoma who are re-treated with chemotherapy remains unknown

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