Severe lung toxicity with a weekly low dose chemotherapy regimen in patients with non-Hodgkin's lymphoma

Nineteen patients in poor prognostic subgroups of aggressive non-Hodgkin's lymphoma (NHL) were treated with weekly chemotherapy consisting of low dose mitoxantrone and cyclophosphamide alternating with bleomycin and vincristine together with continuous oral prednisolone. Six patients developed pneumonitis which was severe in five patients. This occurred at total bleomycin doses of less than 50 U/m2 and cyclophosphamide less than 1875 mg/m2. The 31 per cent incidence of pneumonitis following low dose bleomycin suggests an increased susceptibility to drug-induced pulmonary damage in non-Hodgkin's lymphoma.