ABSTRACT: Noncardiogenic Pulmonary Edema: An Unusual and Serious
Complication of Anticancer Therapy
[04/17/2001; The Oncologist]
Noncardiogenic pulmonary edema (NCPE) is a rare and less well-recognizable
pulmonotoxic syndrome of anticancer therapy than pneumonitis/fibrosis.
NCPE is a clinical syndrome characterized by simultaneous presence
of severe hypoxemia, bilateral alveolar infiltrates on chest
radiograph, and no evidence of left atrial hypertension/congestive
The diagnosis of drug-related NCPE relies upon
documented exclusion of any infectious, metabolic, or cancer-related
causes. The time proximity to therapy with drugs that are known
to precipitate NCPE, any preceding episodes of flu-like symptoms
during previous chemotherapy courses and possible response to
corticosteroids may further support such a diagnosis. Cancer
therapeutic agents clearly associated with NCPE are cytarabine,
gemcitabine, and interleukin-2, as well as all-trans retinoic
acid in acute promyelocytic leukemia patients, while a few other
compounds have rarely or occasionally been implicated.
of lung injury in drug-induced NCPE remains unclear. There are
indications suggesting that both a direct cytotoxic insult to
the lung epithelial cells and induction of a cytokine-triggered
inflammatory response may be involved in its pathogenesis. By
distinction to drug-induced pulmonary pneumonitis that may lead
to permanent pulmonary fibrosis, NCPE if not fatal, can be reversed
upon prompt recognition, following immediate discontinuation
of the offensive drug and start of intensive supportive treatment
and intravenous corticosteroids.
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