Guidelines for Complications of Cancer Treatment Vol VIII Part B

adiographic pattern is the hilar lymphadenopathy seen inassociation with methotrexate use 3 . Pulmonary function testsdemonstrate a restrictive pattern with decreased lung volumesand diffusing lung capacity for carbon monoxide (DL CO). DL COis the most sensitive component of the pulmonary functiontests, with decreases typically occurring before clinicalsymptoms or radiographic changes in patients treated withbleomycin 4 .Bronchoalveolar lavage (BAL) is indicated in patients withunclear ILD, and there is a good correlation between the typeof inflammatory cells obtained by BAL and lung biopsy.Approximate normal percentages in nonsmokers include morethan 80% macrophages, up to 15% lymphocytes, up to 3%neutrophils, up to 0.5% eosinophils, and up to 5% mast cells.BAL may narrow the differential diagnosis by excludinginfection or worsening underlying pathology in addition togrouping disorders according to the cell profileTable 1 Antineoplastic Agent Associated WithPulmonary Toxicity 5ClassCytotoxic antibioticsAnitimetabolitesAlkylating agentsMicrotuble inhibitorsTopoisomerase inhibitorsMonoclonal antibodiesSmall molecule targetedagentsMiscellaneous442AgentsBleomycin,mitomycinMethotrexate, Cytarabine,FludrbineBusulfan, Cyclopho-sphamide,Chrombucil, melphalanTaxanes,Vinca alkaloidsIrinotecanTrastuzumab, Rituximab,Bevacizumab,CetuximabImatinib,Geftinib, ErlotinibATRA,Asparaginase