Unexpected Complication of R-CHOP Chemotherapy: Rapidly Progressive Bronchiolitis Obliterans Syndrome
  • Kenji Nozaki
    Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
  • Sachiko Ezoe
    Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
  • Masanari Hamaguchi
    Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
  • Kazuhito Tsutsumi
    Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
  • Shinsuke Kusakabe
    Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
  • Yoichiro Morikawa
    Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
  • Jiro Fujita
    Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
  • Kentaro Fukushima
    Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
  • Tetsuo Maeda
    Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
  • Hirohiko Shibayama
    Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
  • Atsushi Kumanogo
    Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
  • Yuzuru Kanakura
    Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan

Keywords

Bronchiolitis obliterans syndrome, follicular lymphoma, R-CHOP, chemotherapy-related

Abstract

Background: Bronchiolitis obliterans syndrome (BOS) is the term used for the progressive obliteration of small airways before the patient has had a confirmatory lung biopsy. It is also recognized as a transplant-related complication. There have been no reports of BOS during initial standard chemotherapy.
Case presentation: A 50-year-old woman with newly diagnosed follicular lymphoma grade 2, stage 3A, presented with hypoxia and progressive dyspnoea after the fifth cycle of R-CHOP. High-resolution computed tomography showed air trapping enhanced at the end-expiratory phase. Pulmonary function testing revealed severe obstructive and restrictive failure without bronchodilator response. We diagnosed BOS based on current criteria and treated the patient with glucocorticoids and cyclosporin. She was discharged home on oxygen therapy. However, soon after discharge, her respiratory symptoms deteriorated and she was hospitalized in a palliative care unit. She died of respiratory failure within a year of symptom onset.
Conclusions: This is the first case report to describe rapidly progressive BOS in a patient undergoing R-CHOP treatment, which strongly suggests the condition was caused by the chemotherapy. Although a pathological diagnosis was not obtained, the clinical diagnosis of BOS was important so that the patient could receive appropriate treatment and palliative care based on the prognosis of this incurable condition.

VIEW THE ENTIRE ARTICLE

References

  • Williams KM. How I treat bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. Blood 2017;129(4):448–455.

  • Williams KM, Chien JW, Gladwin MT, Pavletic SZ. Bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation. JAMA 2009;302(3):306–314.

  • Jagasia MH, Greinix HT, Arora M, et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group report. Biol Blood Marrow Transplant 2015;21(3):389–401.e1.

  • Hendrick DJ. "Popcorn worker's lung" in Britain in a man making potato crisp flavouring. Thorax 2008;63(3):267–268.

  • Hsiue TR, Guo YL, Chen KW, Chen CW, Lee CH, Chang HY. Dose-response relationship and irreversible obstructive ventilatory defect in patients with consumption of Sauropus androgynus. Chest 1998;113(1):71–76.

  • Ghanei M, Tazelaar HD, Chilosi M, et al. An international collaborative pathologic study of surgical lung biopsies from mustard gas-exposed patients. Respir Med 2008;102(6):825–830.

  • Nousari HC, Deterding R, Wojtczack H, et al. The mechanism of respiratory failure in paraneoplastic pemphigus. New Engl J Med 1999;340(18):1406–1410.

  • Perez T, Remy-Jardin M, Cortet B. Airways involvement in rheumatoid arthritis: clinical, functional, and HRCT findings. Am J Resp Crit Care Med 1998;157(5 Pt 1):1658–1665.

  • Becroft DM. Bronchiolitis obliterans, bronchiectasis, and other sequelae of adenovirus type 21 infection in young children. J Clin Pathol 1971;24(1):72–82.
  • Hardy KA, Schidlow DV, Zaeri N. Obliterative bronchiolitis in children. Chest 1988;93(3):460–466.

  • Devouassoux G, Cottin V, Liote H, et al. Characterisation of severe obliterative bronchiolitis in rheumatoid arthritis. Eur Respir J 2009;33(5):1053–1061.

  • Lyle WH. D-Penicillamine and fatal obliterative bronchiolitis. Br Med J 1977;1(6053):105.

  • Schwartzman KJ, Bowie DM, Yeadon C, Fraser R, Sutton ED, Levy RD. Constrictive bronchiolitis obliterans following gold therapy for psoriatic arthritis. Eur Resp J 1995;8(12):2191–2193.

  • Nishihara T, Nakano H, Nogami H, et al. A 63-year-old woman with progressive dyspnea after remission of lymphoma. Chest 2017;151(3):e57–e62.

  • Estenne M, Maurer JR, Boehler A, et al. Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria. J Heart Lung Transplant 2002;21(3):297–310.

  • Cooper JD, Billingham M, Egan T, et al. A working formulation for the standardization of nomenclature and for clinical staging of chronic dysfunction in lung allografts. J Heart Lung Transplant 1993;12(5):713–716.

    • Views: 1030
    HTML downloads: 267
    PDF downloads: 482

    Published: 2019-10-28
    Issue: Vol 6 No 11 (view)

    How to cite:
    1.
    Nozaki K, Ezoe S, Hamaguchi M, Tsutsumi K, Kusakabe S, Morikawa Y, Fujita J, Fukushima K, Maeda T, Shibayama H, Kumanogo A, Kanakura Y. Unexpected Complication of R-CHOP Chemotherapy: Rapidly Progressive Bronchiolitis Obliterans Syndrome. EJCRIM 2019;6 doi:10.12890/2019_001266.