Lung Damage Following Blood Cancer Treatment

One of the lesser-known side effects of treatment for blood and marrow cancers is lung damage. This type of lung damage may also be called pulmonary toxicity or lung toxicity. Pulmonary toxicity can range from inflammation of the lining of the lungs to permanent scarring of the lung tissues. It has been estimated that as many as 10% of patients who receive chemotherapy—at least the types of chemotherapy used for blood cancers—will have pulmonary side effects.

Older man coughing into napkin
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Pulmonary toxicity is a potential side effect of both chemotherapy and radiotherapy. What causes pulmonary toxicity is not clearly understood. However, scientists have discovered a number of factors that they feel play a role in how pulmonary toxicity develops.

  • Interaction between chemotherapy and radiotherapy with oxygen molecules
  • A direct toxic effect on the DNA of lung cells
  • Inflammatory response of the lung tissues following exposure to chemotherapy or radiation


Symptoms of treatment-related pulmonary toxicity are fairly non-specific and can easily be confused with other lung conditions. Common signs of treatment-related lung damage include:

  • Dry cough
  • Shortness of breath
  • Chest pain
  • Rapid breathing
  • Difficulty catching your breath
  • Fever

In some cases, signs of pulmonary toxicity may become evident during treatment, or it may take several months for symptoms to begin. On average, symptoms related to lung damage begin 6 to 8 weeks after the onset of treatment, however, it can also take years for damage to become evident.

Because these symptoms are similar to other conditions that can be experienced by cancer patients such as pneumonia or the spread of malignant cells into the lungs, specialists must rule these out before assuming a diagnosis of treatment-related pulmonary toxicity. In other words, lung toxicity is a "diagnosis of exclusion."

Treatments Most Likely to Cause Pulmonary Toxicity

Many types of chemotherapy drugs have been linked to pulmonary toxicity. Some of the most common that are used in the treatment of blood and marrow cancers are:

  • Bleomycin
  • Methotrexate
  • Cyclophosphamide
  • Busulfan

Radiation therapy to the chest area may also cause pulmonary toxicity. This effect may be more pronounced if you have received radiotherapy in combination with chemo.

Risk Factors

The factors that place certain patients at higher risk of developing pulmonary toxicity are unclear and often debated. However, the following have been proposed as risk factors:

  • Increased age
  • Combination chemotherapy
  • Route of chemotherapy administration
  • Radiation therapy in combination with chemotherapy
  • Kidney problems
  • Underlying lung disease
  • History of smoking
  • Previous exposure to asbestos
  • High doses of chemotherapy
  • Colony stimulating factor (G-CSF) as a supportive medication in bleomycin regimens (medications such as Neupogen and Neulasta which raise your white blood cell count)
  • Use of oxygen therapy during chemotherapy cycles
  • People who have had an organ transplant


Identifying patients with pulmonary toxicity can be very difficult on account of the non-specific signs and symptoms and the lack of definitive testing options. For the most part, specialists arrive at a diagnosis of treatment-related pulmonary toxicity after all other causes, such as pneumonia, have been excluded.

Clinicians will typically use blood tests such as a complete blood count with differential, chest X-rays or CT scans, pulmonary function testing (PFT), and sometimes bronchoscopy to rule out infection or spread of cancer cells in the lungs as a cause of symptoms. If no other reason can be identified, and you have had a high-risk therapy recently, your specialist may determine that your lung problems have been caused by your cancer treatment.


If your healthcare provider strongly suspects that your lung damage is related to one of the treatments or medications you are receiving, they will most likely stop that agent. In some cases, they may replace the medication with another less toxic one or just eliminate the drug altogether. While it can be distressing to have a change in your therapy, your healthcare provider would not take this decision lightly.

There is no specific treatment for lung damage caused by cancer therapies, there are a few things that might help with the symptoms you might experience. These include:

  • Steroids to decrease the inflammation in your lungs
  • Cautious use of oxygen therapy
  • Narcotics to help relieve discomfort and help relieve the shortness of breath
  • Relaxation exercises
  • Respiratory physiotherapy (pulmonary rehabilitation)
  • Quitting smoking
  • Physical activity and exercise

Life After Pulmonary Toxicity

Serious cases of pulmonary toxicity can be fatal. In some cases, the lung damage caused by cancer treatment may be permanent. However, in many circumstances, when patients survive these adverse lung reactions, they recover completely with no residual effects remaining.

A Word From Verywell

Lung damage can result from either chemotherapy or radiotherapy in the treatment of cancer. As our therapies for blood and marrow cancers have become more effective, people are living much longer than ever before after treatment. Therefore, care plans need to take into account the long term impact of respiratory toxicity in addition to the potential to cure these conditions.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Feldman, Darren, MD., Vander Els,Nicholas MD. Bleomycin-induced lung injury. UpToDate.

  2. Williams JP, Johnston CJ, Finkelstein JN. Treatment for radiation-induced pulmonary late effects: spoiled for choice or looking in the wrong direction?Curr Drug Targets. 2010;11(11):1386–1394. doi:10.2174/1389450111009011386

  3. Maldonado, F., Limper, A., and J. Jett.  Pulmonary toxicity associated with antineoplastic therapy: Cytotoxic agents UpToDate.

Additional Reading
  • Kamp DW. Asbestos-induced lung diseases: an updateTransl Res. 2009;153(4):143–52. doi:10.1016/j.trsl.2009.01.004

  • Maldonado, F., Limper, A., and J. Jett. Pulmonary toxicity associated with antineoplastic therapy: Cytotoxic agents. UpToDate.

  • Pal, S. Bleomycin Induced Lung Injury. UpToDate.

  • Shippee BM, Bates JS, Richards KL. The role of screening and monitoring for bleomycin pulmonary toxicity. J Oncol Pharm Pract. 2016;22(2):308-12. (Epub ahead of print).

By Karen Raymaakers
Karen Raymaakers RN, CON(C) is a certified oncology nurse that has worked with leukemia and lymphoma patients for over a decade.