Clinical study of interstitial pneumonia in acute lymphoblastic leukemia children under anti-cancer therapy

Interstitial pneumonia is a serious infectious complication of leukemia patients under anti-cancer therapy. The common pathogens could be virus and Pneumocystis carinii or complications from radiotherapy. Eight of forty-nine ALL cases accompanied with interstitial pneumonia were studied during the period from Jan. 1981 to Aug. 1985 with a morbidity rate of 16.3% and a mortality rate of 37.5% (3/8). The most common clinical manifestations were sudden onset of fever (8/8), dyspnea 8), cough (7/8), nasal flaring (3/8) and cyanosis (2/8), with a characteristic sign of bilateral diffuse pulmonary infiltrates on chest X-rays without any moist rale on auscultation. Lung biopsy was performed in one case, P. carinii infection was discovered. Seven of the eight cases occurred during remission and only one case was noted during induction. The intervals between chemotherapy and onset of pneumonia ranged from 2 to 6 months. They were treated with trimethoprimsulfamethoxazole, sometimes combined with antibiotics. Three cases died and five cases recovered. Early diagnosis and treatment or even prophylaxis for P. carinii infection may be very important in curing immunocompromised patients of this disease.