Unexpected Complication of R-CHOP Chemotherapy: Rapidly Progressive Bronchiolitis Obliterans Syndrome

Authors

• Kenji Nozaki Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
• Sachiko Ezoe Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
• Masanari Hamaguchi Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
• Kazuhito Tsutsumi Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
• Shinsuke Kusakabe Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
• Yoichiro Morikawa Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
• Jiro Fujita Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
• Kentaro Fukushima Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
• Tetsuo Maeda Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
• Hirohiko Shibayama Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
• Atsushi Kumanogo Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
• Yuzuru Kanakura Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan

kenjiplace@yahoo.co.jp

Keywords

Abstract

Background: Bronchiolitis obliterans syndrome (BOS) is the term used for the progressive obliteration of small airways before the patient has had a confirmatory lung biopsy. It is also recognized as a transplant-related complication. There have been no reports of BOS during initial standard chemotherapy.
Case presentation: A 50-year-old woman with newly diagnosed follicular lymphoma grade 2, stage 3A, presented with hypoxia and progressive dyspnoea after the fifth cycle of R-CHOP. High-resolution computed tomography showed air trapping enhanced at the end-expiratory phase. Pulmonary function testing revealed severe obstructive and restrictive failure without bronchodilator response. We diagnosed BOS based on current criteria and treated the patient with glucocorticoids and cyclosporin. She was discharged home on oxygen therapy. However, soon after discharge, her respiratory symptoms deteriorated and she was hospitalized in a palliative care unit. She died of respiratory failure within a year of symptom onset.
Conclusions: This is the first case report to describe rapidly progressive BOS in a patient undergoing R-CHOP treatment, which strongly suggests the condition was caused by the chemotherapy. Although a pathological diagnosis was not obtained, the clinical diagnosis of BOS was important so that the patient could receive appropriate treatment and palliative care based on the prognosis of this incurable condition.