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Post-Transplant Events

Fatal pulmonary fibrosis associated with BCNU: the relative role of platelet-derived growth factor-B, insulin-like growth factor I, transforming growth factor-β1 and cyclooxygenase-2

Bone Marrow Transplantation volume 34, pages 609–614 (2004)Cite this article

Summary:

Pulmonary fibrosis is a severe complication associated with bis-chloronitrosourea (BCNU) therapy. However, the pathogenetic mechanism has never been well investigated. We report here a 26-year-old female with diffuse large B-cell lymphoma who died of severe pulmonary fibrosis 81 days after the administration of high-dose BCNU (600 mg/m2). Thoracoscopic wedge resection of left upper lung performed 10 days before patient's death showed severe pulmonary fibrosis with prominent hyperplasia of alveolar macrophages and type II pneumocytes. We further used immunohistochemistry (IHC) to examine the relative role of platelet-derived growth factor-B (PDGF-B), insulin-like growth factor I (IGF-I), transforming growth factor-β1 (TGF-β1) and cyclooxygenase-2 (COX-2) in the pathogenesis of BCNU-related pulmo-nary fibrosis. Strong expressions of PDGF-B and IGF-1 on alveolar macrophages and type II pneumocytes were clearly demonstrated, but in contrast, the expressions of TGF-β1 and COX-2 were almost undetectable. In conclusion, pulmonary fibrosis can develop early and progress rapidly after the administration of high-dose BCNU. The markedly increased expression of fibrogenic factors PDGF-B and IGF-1 on hyperplastic alveolar macrophages and hyperplastic type II pneumocytes may play an important role in the fibrogenesis of this disease. These novel findings may offer specific therapeutic targets in the treatment of BCNU-associated pulmonary fibrosis.

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Authors and Affiliations

  1. Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan

    Y-C Shen, C-F Chiu & S-P Yeh

  2. Department of Medical Research, Cancer Research Center, China Medical University Hospital, Taichung, Taiwan

    K-C Chow

  3. Department of Pathology, China Medical University Hospital, Taichung, Taiwan

    C-L Chen

  4. Department of Medical Research, Stem Cell Research Lab, China Medical University Hospital, Taichung, Taiwan

    C-L Chen, Y-C Liaw & S-P Yeh

  5. China Medical University, Taichung, Taiwan

    C-F Chiu & S-P Yeh

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  1. Y-C Shen
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Correspondence to S-P Yeh.

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Shen, YC., Chiu, CF., Chow, KC. et al. Fatal pulmonary fibrosis associated with BCNU: the relative role of platelet-derived growth factor-B, insulin-like growth factor I, transforming growth factor-β1 and cyclooxygenase-2. Bone Marrow Transplant 34, 609–614 (2004). https://doi.org/10.1038/sj.bmt.1704616

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