Pulmonary arterial occlusive disease following chemotherapy and bone marrow transplantation for leukaemia

Abstract.

Cancer treatment is not known to cause obstructive lesions in the pulmonary artery. We report the case of an 8-year-old girl in whom apparent primary pulmonary hypertension developed shortly after chemotherapy and bone marrow transplantation for myelomonocytic leukaemia (LAME 91 protocol). Cardiac catheterisation showed, at baseline, severe precapillary pulmonary hypertension (mean pulmonary arterial pressure 49 mm Hg) with an increase in pulmonary vascular resistance (23.3 U/m²). Prostacyclin infusion demonstrated a 49% reduction and diltiazem infusion a 30% reduction in pulmonary vascular resistance without significant modification of systemic vascular resistance or cardiac output. Significant improvement in functional status was obtained with oral diltiazem. Follow-up cardiac catheterisation 3 months later showed a maintained haemodynamic improvement. Conclusion: pulmonary arterial occlusive disease should be added to the list of complications likely to occur after cancer chemotherapy. In addition, our report demonstrates that the pulmonary vasodilator response of vasodilating agents should be tested in such patients.