The incidence, characteristics and risk factors of interstitial pneumonia (IP) in patients with lymphoma receiving first-line chemotherapy remained unclear.
Between 2009 and 2014, 2212 consecutive patients with newly diagnosed lymphoma were enrolled as subjects. IP was defined as diffuse pulmonary interstitial infiltrates found on computed tomography scans. IP was observed in 106 patients. Of these, 23 were excluded from the study: 6 due to infection, 7 due to clinical trials with new drugs, 8 due to onset during salvage chemotherapy for recurrent/relapsed lymphoma, 2 due to incomplete medical records. Finally, 83 patients with IP were included in this study. The clinical features, laboratory results, and histological types were analyzed. Patients were paired according to age, sex and pathological type. Risk factors of IP were investigated with matched pair analysis.
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 courses before IP was 3 cycles. The median time from the cessation of chemotherapy to IP was 17 days. All patients were administrated with glucocorticoids, but 11 (13.3%) developed respiratory failure, and 3 (3.6%) died from a progression of pneumonia. Sixty-six (79.5%) patients experienced chemotherapy delays, and 14 (16.9%) had premature termination of their chemotherapy. Sixty-nine patients were re-treated with chemotherapy after remission of IP, of which 22 (31.9%) experienced IP recurrence. The incidence of IP recurrence was significantly higher in patients re-treated with previous regimen than those with alternative regimen (65.4% vs. 11.6%, P
IP is a rare but life-threatening complication in lymphoma patients. Therapy with glucocorticoids may be a favorable strategy for IP. However, IP may recur in patients re-treated with chemotherapy, especially when previous regimen is re-administrated.
Clinical trial identification
Legal entity responsible for the study
Peking University Cancer Hospital
National Natural Science Foundation of China (Grant No. 81241073)
All authors have declared no conflicts of interest.