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Respiratory Complications After Chemotherapy
Source: Late Effects of Treatment for Childhood Cancer (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: April 14, 2025 · Captured 2026-09-09.
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Chemotherapy agents with potential pulmonary toxic effects commonly used in the treatment of pediatric malignancies include bleomycin, busulfan, and the nitrosoureas (carmustine and lomustine). These agents induce lung damage on their own or potentiate the damaging effects of radiation to the lung.
Combined-modality therapy, including pulmonary toxic chemotherapy and thoracic radiation therapy or thoracic/chest wall surgery, increases the risk of pulmonary function impairment.[7]
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Evidence (outcomes among cohorts treated with pulmonary toxic chemotherapy):
The development of bleomycin-associated pulmonary fibrosis with permanent restrictive disease is dose dependent, usually occurring at doses greater than 200 U/m2 to 400 U/m2, higher than those used in treatment protocols for pediatric malignancies.[16,17]
Pediatric regimens for Hodgkin lymphoma using radiation therapy and doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) have shown a significant incidence of asymptomatic pulmonary dysfunction after treatment, which appears to improve with time.[18] However, grades 3 and 4 pulmonary toxicity was reported in 9% of children receiving 12 cycles of ABVD followed by 21 Gy of extended-field radiation.[17]
ABVD-related pulmonary toxic effects may result from fibrosis induced by bleomycin or radiation recall pneumonitis related to administration of doxorubicin.
One series included 207 children who were treated with bleomycin for Hodgkin lymphoma or germ cell tumors and had pulmonary function tests at least 1 year after the completion of therapy. At least one pulmonary function abnormality was present in 52.5% of patients. Obstructive lung disease was noted in 22.7% of patients, restrictive lung disease in 7.5%, hyperinflation in 28.8%, and nonuniform ventilation in 14%. Very few patients had pulmonary symptoms.[19]
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Preserved source evidence · Not medical advice