Affiliations: Ospedale “E. Morelli”
Memorial Sloan-Kettering Cancer Center,
New York, NY
Correspondence to: Almerico Marruchella, MD, Divisione di Broncopneumologia, Ospedale “E. Morelli,” 23039 Sondalo (SO), Italy
To the Editor:
We read with great interest the report by Vander Els and Miller
(December 1998),1 regarding a patient with diffuse
infiltrative lung disease during chemotherapy with gemcitabine that
showed a favorable response to corticosteroids.
Pavlakis et al2 described severe pulmonary toxicity in
three patients treated with gemcitabine: two of them died, and autopsy
revealed diffuse alveolar damage. In a third patient, the results of
transbronchial biopsy showed a pattern of nonspecific interstitial
pneumonia, and corticosteroids allowed a clinical improvement.
We reported a similar case of a man who died due to progressive
respiratory failure, despite the administration of high-dose IV
corticosteroids.3 In our patient, autopsy revealed a
pattern of diffuse alveolar damage.
We suggest that different patterns of lung injury may be related to
gemcitabine, as has been described for other drugs.4 In
the case reported by Vander Els and Miller,1 the
patient’s rapid response, following the administration of
corticosteroids, makes it likely a hypersensitivity reaction.
We think that BAL may be of value in elucidating mechanisms involved in
drug toxicity, and that it should be used more extensively in clinical
practice because it is safe for use in treating critical-care patients.
A cellular profile suggestive of hypersensitivity reaction may help in
excluding other causes and probably predicts a good response to
We thank Drs. Maruchella and Tondini for their comments on our
study (December 1998).1In addition to the reports cited,
there have been several patient deaths in Japan that were attributable
to gemcitabine pulmonary toxicity.2–3
The pathophysiology of gemcitabine pulmonary toxicity can be inferred
only from the present data. We agree with Drs. Maruchella and Tondini
on the importance of collecting BAL as well as biopsy material.
Autopsies, although helpful, are limited in that they show the end
stage of the injury rather than the path of progression.
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