As therapy for leukemia and lymphoma has improved, secondary pulmonary disease has become a major cause of death. In this review of 225 patients with leukemia or lymphoma, six possibly preventable deaths resulted because progressive pulmonary infiltrates were treated without tissue diagnosis. Four other patients died of undiagnosed second primary lung tumors.
When pulmonary infiltrates were diagnosed by open lung biopsy examination, appropriate therapy in nine patients resulted in seven survivals from potentially lethal infections. Of six patients with discrete lesions compatible with either primary lung tumor, leukemic infiltrate, or lymphomatous nodule, bronchoscopy and brush biopsy examination revealed bronchogenic tumors, leading to appropriate surgical therapy and survival in three. In three others, bronchoscopy and mediastinoscopy suggested exacerbation of the primary disease, which was treated satisfactorily by radiotherapy.
Thus, when pulmonary disease develops in patients with leukemia or lymphoma, aggressive therapy based on tissue diagnosis may avert untimely death.