Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Korean J Intern Med. 2010 Mar;25(1):86-92. doi: 10.3904/kjim.2010.25.1.86. Epub 2010 Feb 26.
BACKGROUND/AIMS: The aim of our study was to determine the incidence and clinical features of severe pulmonary complications in patients receiving cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or rituximab plus CHOP (R-CHOP) as the initial treatment for lymphoma.
A retrospective analysis of pulmonary infection and drug-induced interstitial pneumonitis (DIIP) was performed using lymphoma registry data. R-CHOP was administered in 71 patients and CHOP in 29 patients.
The severe pulmonary adverse events tended to occur more frequently with R-CHOP (18.3%) than CHOP alone (13.8%), although the difference was not significant (p = 0.771). DIIP occurred in five patients in the R-CHOP arm (7%) and in one in the CHOP arm (3%). The continuous use of steroids for conditions other than lymphoma significantly increased the risk of pulmonary infection including Pneumocystis jiroveci pneumonia (p = 0.036) in the multivariate analysis. International prognostic index, tumor stage, smoking, previous tuberculosis, chronic obstructive pulmonary disease, and lymphoma involvement of lung parenchyma were not related to pulmonary adverse events. Patients who experienced severe pulmonary events showed shorter survival when compared to those without complications (p = 0.002).
Our experiences with serial cases with DIIP during chemotherapy and the correlation of continuous steroid use with pulmonary infection suggest that the incidence of pulmonary complications might be high during lymphoma treatment, and careful monitoring should be performed.
背景/目的：我们的研究目的是确定接受环磷酰胺、多柔比星、长春新碱和泼尼松（CHOP）或利妥昔单抗联合 CHOP（R-CHOP）作为淋巴瘤初始治疗的患者发生严重肺部并发症的发生率和临床特征。
使用淋巴瘤登记数据对肺部感染和药物诱导的间质性肺炎（DIIP）进行回顾性分析。71 例患者接受 R-CHOP 治疗，29 例患者接受 CHOP 治疗。
尽管差异无统计学意义（p = 0.771），但 R-CHOP 组（18.3%）严重肺部不良事件的发生率高于 CHOP 组（13.8%）。R-CHOP 组中有 5 例（7%）发生 DIIP，CHOP 组中有 1 例（3%）发生 DIIP。在多变量分析中，除淋巴瘤以外的疾病持续使用类固醇会显著增加肺部感染（包括卡氏肺孢子虫肺炎）的风险（p = 0.036）。国际预后指数、肿瘤分期、吸烟、既往肺结核、慢性阻塞性肺疾病和淋巴瘤累及肺实质与肺部不良事件无关。与无并发症的患者相比，发生严重肺部事件的患者的生存时间更短（p = 0.002）。
我们在化疗期间对 DIIP 进行了连续病例的经验，以及连续使用类固醇与肺部感染的相关性表明，淋巴瘤治疗期间肺部并发症的发生率可能很高，应进行仔细监测。
