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Pneumonia During Therapy for Childhood Acute Lymphoblastic Leukemia

Pneumonia During Therapy for Childhood Acute Lymphoblastic Leukemia Abstract • The incidence of pneumonia was evaluated in 844 children undergoing initial treatment for acute lymphoblastic leukemia (ALL). A total of 310 episodes occurred in 239 patients followed up for five to 36 months after diagnosis. The peak incidences occurred in the periods 0 to 20 days and 40 to 80 days after the start of antileukemic therapy. Bacterial pneumonias occurred primarily during the first 20 days after diagnosis of ALL. No episode of Pneumocystis carinii pneumonia was noted before 40 days, and the majority of instances occurred 50 to 120 days after diagnosis. In 80% of all episodes, a specific causative organism was not detected. The incidence of P carinii pneumonia was greater in patients receiving intrathecal methotrexate as part of CNS prophylaxis than in those receiving only CNS irradiation. Pneumonia is a frequent event during the therapy of ALL in childhood. (Am J Dis Child 134:28-34, 1980) References 1. Levine AS, Schimpff SC, Graw RG Jr, et al: Hematologic malignancies and other marrow failure states: Progress in the management of complicating infections . Semin Hematol 11:141-205, 1974. 2. Bodey GP, Powell RD Jr, Hersh EM: Pulmonary complications of acute leukemia . Cancer 19:781-793, 1966.Crossref 3. Hughes WT, Feldman S, Cox F: Infectious diseases in children with cancer . Pediatr Clin North Am 21:583-615, 1974. 4. Hughes WT, Smith DR: Infection during induction of remission in acute lymphocytic leukemia . Cancer 31:1008-1014, 1973.Crossref 5. Hersh EM, Bodey GP, Nies BA, et al: Causes of death in acute leukemia . JAMA 193:105-109, 1965.Crossref 6. Simone JV, Holland E, Johnson W: Fatalities during remission of childhood leukemia . Blood 39:759-770, 1972. 7. Iacuone JJ, Wong KY, Bove KE, et al: Acute respiratory illness in children with acute lymphoblastic leukemia . J Pediatr 90:915-919, 1977.Crossref 8. Rubin P, Casarett GW: Clinical Radiation Pathology . Philadelphia, WB Saunders Co, 1968, vol 1, pp 423-470. 9. Wohl MEB, Griscom NT, Traggis DG: Effects of therapeutic irradiation delivered in early childhood upon subsequent lung function . Pediatrics 55:507-516, 1975. 10. Smith JC: Radiation pneumonitis . Am Rev Respir Dis 87:647-655, 1963. 11. Boushy SF, Helgason AH, North LB: The effect of radiation on the lung and bronchial tree . Am J Roentgenol 108:284-292, 1960.Crossref 12. Weir GJ, Michaelson SM: Pulmonary Radiation Reactions . Springfield, Ill, Charles C Thomas Publishers, 1971. 13. Whitfield AGW, Bond WH, Kunkler PB: Radiation damage to thoracic tissues . Thorax 18:371-380, 1963.Crossref 14. Clarysse AM, Cathey WJ, Cartwright GE, et al: Pulmonary disease complicating intermittent therapy with methotrexate . JAMA 209:1861-1864, 1969.Crossref 15. Robbins KM, Gribetz E, Strauss L, et al: Pneumonitis in acute lymphatic leukemia during methotrexate therapy . J Pediatr 82:84-88, 1963.Crossref 16. Whitcomb ME, Schwartz MI, Tormey DC: Methotrexate pneumonitis: Case report and review of the literature . Thorax 27:636-639, 1972.Crossref 17. Everts CS, Westcott JL, Bragg DG: Methotrexate therapy and pulmonary disease . Radiology 107:539-543, 1973.Crossref 18. Bhat KSS, Anderson KR, Stewart RDH: Lung disease associated with methotrexate therapy . Aust NZ J Med 4:277-280, 1974.Crossref 19. Lisbona A, Schwartz J, Lachance C, et al: Methotrexate-induced pulmonary disease . J Canad Assoc Radiol 24:215-220, 1973. 20. Iyer R, Ravindramath Y, Kulkaini R, et al: Bilateral interstitial pneumonia in acute lymphoblastic leukemia . Am J Hematol 1:225-235, 1976.Crossref 21. Peto R, Pike MC, Armitage P, et al: Design and analysis of randomized clinical trials requiring prolonged observation of each patient: II. Analysis and examples . Br J Cancer 35:1-39, 1977.Crossref 22. Wilder CS: Acute respiratory illnesses reported to the US National Health Survey during 1957-1962 . Am Rev Respir Dis 88:14-21, 1963. 23. Glezen WP, Loda FA, Clyde WA, et al: Epidemiologic patterns of acute lower respiratory disease of children in a pediatric group practice . J Pediatr 78:397-406, 1971.Crossref 24. Wolff LJ, Bartlett MS, Baehner RL, et al: The causes of interstitial pneumonitis in immunocompromised children: An aggressive systematic approach to diagnosis . Pediatrics 60:41-45, 1977. 25. Bodey GP, Buckley M, Sathe YS, et al: Quantitative relationship between circulating leukocytes and infection in patients with acute leukemia . Ann Intern Med 64:328-340, 1966.Crossref 26. Ruebush TK, Weinstein RA, Baehner RL, et al: An outbreak of pneumocystis pneumonia in children with acute lymphocytic leukemia . Am J Dis Child 132:143-148, 1978. 27. Newhouse M, Sanchis J, Bieronstock J: Lung defense mechanisms . N Engl J Med 295:1045-1052, 1976.Crossref 28. Sieger L: Pulmonary alveolar macrophages in pre- and post-natal rabbits . J Reticuloendothel Soc 23:389-395, 1978. 29. Hughes WT, Kuhn RN, Chaudhary MD, et al: Successful chemoprophylaxis for Pneumocystis carinii pneumonitis . N Engl J Med 297:1419-1426, 1977.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Pneumonia During Therapy for Childhood Acute Lymphoblastic Leukemia

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Publisher
American Medical Association
Copyright
Copyright © 1980 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1980.02130130020007
Publisher site
See Article on Publisher Site

Abstract

Abstract • The incidence of pneumonia was evaluated in 844 children undergoing initial treatment for acute lymphoblastic leukemia (ALL). A total of 310 episodes occurred in 239 patients followed up for five to 36 months after diagnosis. The peak incidences occurred in the periods 0 to 20 days and 40 to 80 days after the start of antileukemic therapy. Bacterial pneumonias occurred primarily during the first 20 days after diagnosis of ALL. No episode of Pneumocystis carinii pneumonia was noted before 40 days, and the majority of instances occurred 50 to 120 days after diagnosis. In 80% of all episodes, a specific causative organism was not detected. The incidence of P carinii pneumonia was greater in patients receiving intrathecal methotrexate as part of CNS prophylaxis than in those receiving only CNS irradiation. Pneumonia is a frequent event during the therapy of ALL in childhood. (Am J Dis Child 134:28-34, 1980) References 1. Levine AS, Schimpff SC, Graw RG Jr, et al: Hematologic malignancies and other marrow failure states: Progress in the management of complicating infections . Semin Hematol 11:141-205, 1974. 2. Bodey GP, Powell RD Jr, Hersh EM: Pulmonary complications of acute leukemia . Cancer 19:781-793, 1966.Crossref 3. Hughes WT, Feldman S, Cox F: Infectious diseases in children with cancer . Pediatr Clin North Am 21:583-615, 1974. 4. Hughes WT, Smith DR: Infection during induction of remission in acute lymphocytic leukemia . Cancer 31:1008-1014, 1973.Crossref 5. Hersh EM, Bodey GP, Nies BA, et al: Causes of death in acute leukemia . JAMA 193:105-109, 1965.Crossref 6. Simone JV, Holland E, Johnson W: Fatalities during remission of childhood leukemia . Blood 39:759-770, 1972. 7. Iacuone JJ, Wong KY, Bove KE, et al: Acute respiratory illness in children with acute lymphoblastic leukemia . J Pediatr 90:915-919, 1977.Crossref 8. Rubin P, Casarett GW: Clinical Radiation Pathology . Philadelphia, WB Saunders Co, 1968, vol 1, pp 423-470. 9. Wohl MEB, Griscom NT, Traggis DG: Effects of therapeutic irradiation delivered in early childhood upon subsequent lung function . Pediatrics 55:507-516, 1975. 10. Smith JC: Radiation pneumonitis . Am Rev Respir Dis 87:647-655, 1963. 11. Boushy SF, Helgason AH, North LB: The effect of radiation on the lung and bronchial tree . Am J Roentgenol 108:284-292, 1960.Crossref 12. Weir GJ, Michaelson SM: Pulmonary Radiation Reactions . Springfield, Ill, Charles C Thomas Publishers, 1971. 13. Whitfield AGW, Bond WH, Kunkler PB: Radiation damage to thoracic tissues . Thorax 18:371-380, 1963.Crossref 14. Clarysse AM, Cathey WJ, Cartwright GE, et al: Pulmonary disease complicating intermittent therapy with methotrexate . JAMA 209:1861-1864, 1969.Crossref 15. Robbins KM, Gribetz E, Strauss L, et al: Pneumonitis in acute lymphatic leukemia during methotrexate therapy . J Pediatr 82:84-88, 1963.Crossref 16. Whitcomb ME, Schwartz MI, Tormey DC: Methotrexate pneumonitis: Case report and review of the literature . Thorax 27:636-639, 1972.Crossref 17. Everts CS, Westcott JL, Bragg DG: Methotrexate therapy and pulmonary disease . Radiology 107:539-543, 1973.Crossref 18. Bhat KSS, Anderson KR, Stewart RDH: Lung disease associated with methotrexate therapy . Aust NZ J Med 4:277-280, 1974.Crossref 19. Lisbona A, Schwartz J, Lachance C, et al: Methotrexate-induced pulmonary disease . J Canad Assoc Radiol 24:215-220, 1973. 20. Iyer R, Ravindramath Y, Kulkaini R, et al: Bilateral interstitial pneumonia in acute lymphoblastic leukemia . Am J Hematol 1:225-235, 1976.Crossref 21. Peto R, Pike MC, Armitage P, et al: Design and analysis of randomized clinical trials requiring prolonged observation of each patient: II. Analysis and examples . Br J Cancer 35:1-39, 1977.Crossref 22. Wilder CS: Acute respiratory illnesses reported to the US National Health Survey during 1957-1962 . Am Rev Respir Dis 88:14-21, 1963. 23. Glezen WP, Loda FA, Clyde WA, et al: Epidemiologic patterns of acute lower respiratory disease of children in a pediatric group practice . J Pediatr 78:397-406, 1971.Crossref 24. Wolff LJ, Bartlett MS, Baehner RL, et al: The causes of interstitial pneumonitis in immunocompromised children: An aggressive systematic approach to diagnosis . Pediatrics 60:41-45, 1977. 25. Bodey GP, Buckley M, Sathe YS, et al: Quantitative relationship between circulating leukocytes and infection in patients with acute leukemia . Ann Intern Med 64:328-340, 1966.Crossref 26. Ruebush TK, Weinstein RA, Baehner RL, et al: An outbreak of pneumocystis pneumonia in children with acute lymphocytic leukemia . Am J Dis Child 132:143-148, 1978. 27. Newhouse M, Sanchis J, Bieronstock J: Lung defense mechanisms . N Engl J Med 295:1045-1052, 1976.Crossref 28. Sieger L: Pulmonary alveolar macrophages in pre- and post-natal rabbits . J Reticuloendothel Soc 23:389-395, 1978. 29. Hughes WT, Kuhn RN, Chaudhary MD, et al: Successful chemoprophylaxis for Pneumocystis carinii pneumonitis . N Engl J Med 297:1419-1426, 1977.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Jan 1, 1980

References