As part of my husband's pre-transplant testing, they discovered new damage - peripheral scarring - on my husband's lungs. The likely culprit is Cytoxan (cyclophosphamide), as he was on CyBorD (Cytoxan, Velcade, dex) for 5 months as induction chemo.
He's off chemo now, and taking prednisone and doing pulmonary rehab exercises to see if his lungs can improve. Although he did cell collection, any transplant is in doubt because if Cytoxan was the problem, then melphalan could make things much worse.
Has anyone seen this? It appears to be quite rare. We have CT and VQ (lung ventilation / perfusion) scans from May and early July showing his lungs clear, then the damage in August.
Lisa
Forums
5 posts
• Page 1 of 1
-
LisaE - Name: Lisa
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 67
Re: Cytoxan (cyclophosphamide) pulmonary toxicity?
Hi Lisa,
Sorry to hear about the scarring your husband experienced. When I read your post, I was reminded of a similar posting here in the forum recently, but I couldn't find it right away. But I think this is it:
"Can Velcade make COPD worse?", Beacon forum discussion started April 7, 2014.
There may have been others, but my quick check didn't find any.
Apparently, Velcade can cause lung issues in some patients. The prescribing information for Velcade includes the following notice:
Hope this helps a bit.
Sorry to hear about the scarring your husband experienced. When I read your post, I was reminded of a similar posting here in the forum recently, but I couldn't find it right away. But I think this is it:
"Can Velcade make COPD worse?", Beacon forum discussion started April 7, 2014.
There may have been others, but my quick check didn't find any.
Apparently, Velcade can cause lung issues in some patients. The prescribing information for Velcade includes the following notice:
5.4 Pulmonary Toxicity
Acute Respiratory Distress Syndrome (ARDS) and acute diffuse infiltrative pulmonary disease of unknown etiology such as pneumonitis, interstitial pneumonia, lung infiltration have occurred in patients receiving Velcade. Some of these events have been fatal.
Hope this helps a bit.
-
JimNY
Re: Cytoxan (cyclophosphamide) pulmonary toxicity?
Hi Lisa,
Sorry ... I was a bit confused when I was answering your question. I thought you were asking about potential lung damage from Velcade, not Cytoxan.
I'll have to check on Cytoxan, but since your husband received Velcade as part of his treatment in addition to Cytoxan, it's possible that the Velcade was the cause of the lung issues, not the Cytoxan.
Sorry if my posting confused you a bit. Good luck!
Sorry ... I was a bit confused when I was answering your question. I thought you were asking about potential lung damage from Velcade, not Cytoxan.
I'll have to check on Cytoxan, but since your husband received Velcade as part of his treatment in addition to Cytoxan, it's possible that the Velcade was the cause of the lung issues, not the Cytoxan.
Sorry if my posting confused you a bit. Good luck!
-
JimNY
Re: Cytoxan (cyclophosphamide) pulmonary toxicity?
Sorry to learn that your husband also has experienced lung damage.
My husband's lungs were damaged from Velcade. We never read that this was possible ... until after the damage. And his doctor never explained this side effect was possible.
Although my husband's multiple myeloma has been in partial remission for over a year now, his quality of life has been scattered due to his lung issues.
I wish you all the best.
My husband's lungs were damaged from Velcade. We never read that this was possible ... until after the damage. And his doctor never explained this side effect was possible.
Although my husband's multiple myeloma has been in partial remission for over a year now, his quality of life has been scattered due to his lung issues.
I wish you all the best.
-
Pamela Jean
Re: Cytoxan (cyclophosphamide) pulmonary toxicity?
It's been 9 months now, and my husband's lungs appear to be stable.
Consensus is that it was the Cytoxan. It's extremely rare, but the way his lungs reacted was strongly indicative of Cytoxan rather than Velcade.
The good news is that stopping the drug, and prednisone to reduce the inflammation, seems to have worked. My husband was on prednisone for 5 months, but has been off since January. The scarring will never go away, but his February and June pulmonary function tests as well as his February CT show that his lungs have improved and that improvement has been stable. The big fear was that the drug reaction would have kicked off pulmonary fibrosis, so the improvement and stability are a huge relief.
My husband was not able to have his transplant, because if he's got a reaction to Cytoxan, he's certainly not getting high dose melphalan. Despite that, he's been showing no M-spike since January, down from trace levels in August. His lungs are now testing in the 60% range for capacity and 50% for diffusion. He needs to be more careful with exertion, but is exercising and has no major negative impact.
I tried to get some data on the long term effects of Cytoxan toxicity, but there's nothing out there in the literature that I could find. Unlike Velcade, which seems to hit the lungs hard and early, Cytoxan presents like "chemo lung" and does damage more slowly, and onset is unpredictable.
From my sample set of one, it seems that if you catch the problem, stopping the drug and reducing inflammation did arrest the damage and allow some improvement.
Just wanted to update the group.
Consensus is that it was the Cytoxan. It's extremely rare, but the way his lungs reacted was strongly indicative of Cytoxan rather than Velcade.
The good news is that stopping the drug, and prednisone to reduce the inflammation, seems to have worked. My husband was on prednisone for 5 months, but has been off since January. The scarring will never go away, but his February and June pulmonary function tests as well as his February CT show that his lungs have improved and that improvement has been stable. The big fear was that the drug reaction would have kicked off pulmonary fibrosis, so the improvement and stability are a huge relief.
My husband was not able to have his transplant, because if he's got a reaction to Cytoxan, he's certainly not getting high dose melphalan. Despite that, he's been showing no M-spike since January, down from trace levels in August. His lungs are now testing in the 60% range for capacity and 50% for diffusion. He needs to be more careful with exertion, but is exercising and has no major negative impact.
I tried to get some data on the long term effects of Cytoxan toxicity, but there's nothing out there in the literature that I could find. Unlike Velcade, which seems to hit the lungs hard and early, Cytoxan presents like "chemo lung" and does damage more slowly, and onset is unpredictable.
From my sample set of one, it seems that if you catch the problem, stopping the drug and reducing inflammation did arrest the damage and allow some improvement.
Just wanted to update the group.
-
LisaE - Name: Lisa
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 67
5 posts
• Page 1 of 1
Return to Treatments & Side Effects