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Pulmonary Toxicity of Chemotheraputics 30/4/11 PY Mindmaps GENERAL PRINCIPLES 1. rule out pulmonary oedema from congestive cardiac failure 2. rule out lung infection (normal and opportunistic organisms) 3. rule out lung infiltration by cancer cells 4. determine time from chemotherapy to onset of respiratory symptoms -> compare with literature -> rechallenge. 5. check clinical manifestations and laboratory test abnormalities consistent with lung toxicity induced by suspected drug. 6. determine whether symptoms resolve after the drug is stopped and steroids are given. SPECIFICS Bleomycin - 3-40% of patients - pneumonitis with diffuse pulmonary infiltrates and fibrosis - risk factors: -> -> -> -> -> -> -> -> higher cumulative bleomycin dose renal failure > 70 years smoker radiation to chest high O2 concentrations G-CSF administration of other chemotherapeutics with lung toxicity Methotrexate - acute/subacute pneumonitis simulating infection ATRA Lung - All Trans-Retinoic Acid – helps differentiate APL blasts and improve remission and relapse rates - occurs day 2-21 days into treatment - features: fever, leukocytosis, SOB, weight gain, pleural effusions, infiltrates Other - fludarabine - gemcitabine Jeremy Fernando (2011) - cytarabine - cyclophosphamide Jeremy Fernando (2011)