Pulmonary toxicity syndrome in breast cancer patients undergoing BCNU-containing high-dose chemotherapy and autologous hematopoietic cell transplantation
Pulmonary toxicity syndrome in breast cancer patients undergoing BCNU-containing high-dose chemotherapy and autologous hematopoietic cell transplantation
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DOI：
10.1016/s1083-8791(00)70015-2
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发表时间：
2000-01-01
影响因子：
4.3
通讯作者：
Hu, WW
中科院分区：
文献类型：
--
作者：
Cao, TM;Negrin, RS;Hu, WW
我们进行了一项回顾性研究，以探讨肺毒性综合征（PTS）在一个队列的乳腺癌患者接受含卡氮芥的大剂量化疗（HDC）。我们的目的是描述表现，识别危险因素，确定治疗后的结果，并发现与生存差异的任何相关性。我们回顾了152例II或III期或转移性乳腺癌患者的资料，这些患者接受环磷酰胺5625 mg/m2、顺铂165 mg/m2和BCNU 600 mg/m2加热，然后进行自体外周血造血细胞移植。在随访期间，当满足以下标准时，PTS被诊断为：（1）具有PTS的典型临床症状，（2）与HDC前DLCO相比，绝对一氧化碳弥散量（DLCO）下降10%，以及（3）没有活动性肺部感染的临床证据。然后患者接受皮质类固醇治疗。所有152例患者的PTS发生率为59%，中位发病时间为HDC后45天（范围：21-149天）。在诊断PTS时，DLCO绝对下降的中位数为26%（范围，10%-73%）。患者年龄、乳腺癌分期、HDC前化疗方案、HDC前胸壁放疗、吸烟、既往肺部疾病或基线肺功能检查结果与PTS的发生之间无显著相关性。我们确实观察到PTS与转氨酶非胆汁淤积性升高之间存在有趣的相关性。在接受泼尼松治疗的PTS患者中，中位时间为105.5天（范围：44-300天），91%的PTS消退，无肺部后遗症。在3年时，II或III期患者发生PTS的总生存率（OS）为84%（95%置信区间[CI]，73%-95%）;转移性乳腺癌患者发生PTS的OS为58%（95% CI，38%-78%）。这些值与未发生PTS的患者无显著差异（分别为91% [95%置信区间[CI]，81%-100%]和53% [95% CI，32%-74%]）。在有和没有PTS的患者之间没有观察到无疾病或无事件生存率的显著差异。在用含BCNU的HDC方案加热的乳腺癌患者中，PTS的发生率可能非常高。用皮质类固醇治疗一个疗程在绝大多数情况下是成功的。
We performed a retrospective review to investigate pulmonary toxicity syndrome (PTS) in a cohort of breast cancer patients undergoing BCNU-containing high-dose chemotherapy (HDC). Our aim was to characterize presentation, identify risk factors, determine outcome following therapy, and find any association with differences in survival. We reviewed the data of 152 patients with stage II or III or metastatic breast cancer heated with cyclophosphamide 5625 mg/m(2) cisplatin 165 mg/m(2), and BCNU 600 mg/m(2) followed by autologous peripheral blood hematopoietic cell transplantation. During follow-up, PTS was diagnosed when the following criteria were met: (1) presentation with typical clinical symptoms of PTS, (2) an absolute carbon monoxide diffusion capacity (DLCO) decline of 10% compared with pre-HDC DLCO, and (3) no clinical evidence of active pulmonary infection. Patients were then treated with a course of corticosteroid therapy. The incidence of PTS for all 152 patients was 59%, with a median onset at 45 days (range, 21-149 days) post-HDC. The median absolute DLCO decrement was 26% (range, 10%-73%) at diagnosis of PTS. There was no significant correlation between patient age, stage of breast cancer, pre-HDC chemotherapy regimen, pre-HDC chest wall radiotherapy, tobacco use, prior lung disease, or baseline pulmonary function test results and the development of PTS. We did observe an interesting association between PTS and the development of a noncholestatic elevation of transaminases. Of PTS patients treated with prednisone therapy for a median of 105.5 days (range, 44-300 days), 91% achieved resolution of their PTS without pulmonary sequelae. At 3 years, the overall survival (OS) of stage II or III patients who developed PTS was 84% (95% confidence interval [CI], 73%-95%); of metastatic breast cancer patients with PTS, the OS was 58% (95% CI, 38%-78%). These values were not significantly different from those of patients who did not develop PTS (91% [95% confidence interval [CI], 81%-100%] and 53% [95% CI, 32%-74%], respectively). No significant differences in disease-free or event-free survival were observed between patients with and without PTS. The incidence of PTS in breast cancer patients heated with a BCNU-containing a HDC regimen can be remarkably high. Treatment with a course of corticosteroid therapy is successful in the vast majority.