The occurrence of pulmonary disease associated with long-term BCNU therapy is reported in two patients treated for astrocytoma grade I1 whose clinical presentations of pulmonary complications and corresponding tissue alterations showed striking differences. One patient presented with a dramatic, fulminating, and rapidly fatal pulmonary disease. His lungs revealed atypical proliferation of pneumocytes, moderate interstitial inflammation, fibrosis and intra-alveolar hyalin membranes. The second patient presented with slowly progressive dyspnea, ultimately leading to death secondary to severe diffuse alveolar septa1 fibrosis. Individual differences in response to toxicity are suggested and discussed.
Cancer 54~751-755. 1984.
RUG-INDUCED PULMONARY DISEASE is known to be D caused by a variety of drugs.'-' Among these are alkylating agents such as busulfan, cyclophosphamide, and chlorambucil, anticancer antibiotics, such as bleomycin, and the folic acid antagonist, methotrexate. A newer class of chemotherapeutic agents, the nitrosoureas are used to treat a variety of malignant tumors, mainly malignant lymphoma, malignant melanoma, multiple myeloma, primary brain tumors, and certain gastrointestinal tumors. One of the nitrosureas, bischloroethyl nitrosurea (BCNU), has recently been shown to produce diffuse pulmonary disease. This causal relationship was first suggested by Iriarte and coworkers in 1966.6 Subsequently, other investigators have reported pulmonary disease in patients after long-term therapy with BCNU.
In this report, two additional cases are reported in which BCNU therapy is implicated as a cause of diffuse pulmonary pathology. Of special interest is the first case which presented dramatically with the clinical picture of an acute fulminating and rapidly progressive pulmonary disease leading to the patient's rapid death. This unique case provoked a search of the autopsy files of the Department