Lomustine pulmonary toxicity

Lomustine can cause pulmonary infiltrates and fibrosis (6-8), and fatal pulmonary toxicity has occasionally occurred (9). 

Stone MD, Richardson MG. Pulmonary toxicity of lomustine. Cancer Treat Rep 1987 71(7-8) 786-7. 

Dent RG. Fatal pulmonary toxic effects of lomustine. Thorax 1982 37(8) 627-9. 

Both carmustine and lomustine can induce thrombocytopenia and leukopenia, leading to hemorrhage and massive infection. Acute (as well as potentially fatal delayed) pulmonary toxicity also is a risk. Pulmonary toxicity is dose-related, and individuals who received the drug in childhood or early adolescence are at higher risk for the delayed reaction. The grand mal seizures that are possible from the wafer formulation of carmustine appear to result from the wafer rather than from the nitrosourea. 

The main drugs in this group are lomustine, carmustine, semustine and streptozotocin. The nitrosoureas are lipophilic and cross the blood-brain barrier. They are therefore effective against brain tumours. They cause a severe cumulative bone marrow depression that starts within 1-2 months of treatment. Lomustine and carmustine cause direct injury to the pulmonary epithelium leading to alveolar fibrosis. Streptozotocin has little bone marrow toxicity, but destroys the pancreatic 3 cells, causing diabetes mellitus. 

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