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After treatment and remission

Lungs

Some leukaemia treatments — total body irradiation, certain chemotherapy medicines and transplant — can have long-term effects on the lungs. This topic explains the risks, how the lungs are checked and how to protect them.

Last updated: ~2 min read
Clear glowing lungs expanding with a calm breath.
Figure 1.Healthy lungs breathe calmly.

01Short answer

In most people who have had leukaemia the lungs work normally, but risk is higher in some groups. Treatments that can affect the lungs include total body irradiation (before a transplant), chest radiation, some medicines such as busulfan and carmustine, and chronic graft-versus-host disease after an allogeneic transplant. Lung GVHD — bronchiolitis obliterans — narrows the small airways and shows up as a dry cough and breathlessness. Severe pneumonias can also leave scar tissue. People at risk are advised to have lung function tests (spirometry, diffusing capacity). The main ways to protect your lungs are avoiding smoking and second-hand smoke, flu and pneumococcal vaccines, regular activity and reporting new breathing symptoms in time.

02Simple explanation

The lungs usually work normally.

Risk: radiation, some medicines, transplant.

Lung GVHD narrows the small airways.

The check is a lung function test.

The best protection is a smoke-free life.

03Scientific explanation

Radiation and medicines: the COG recommends lung function tests for people who had total body irradiation, chest radiation, busulfan, carmustine or bleomycin.

Bronchiolitis obliterans: under the NIH 2014 consensus, this is the main form of chronic lung GVHD and is detected by a fall in FEV1 on spirometry.

Early detection: regular spirometry after transplant helps find bronchiolitis before symptoms worsen.

Smoking: smoking greatly increases loss of function and lung cancer risk in lungs damaged by treatment.

04What happens in the body?

Which treatments have an effect?

Total body and chest radiation, some chemotherapy medicines (busulfan, carmustine) and lung GVHD after transplant.

What is lung GVHD?

After an allogeneic transplant, donor immune cells can attack the small airways. The airways narrow and breathing becomes harder. It usually starts in the first 2 years after transplant.

A delicate branching of fine glowing airways.
Figure 2.The small airways are like tree branches.

How are the lungs checked?

Spirometry — you breathe in deeply and blow out fast into a device. When needed, a diffusion test, chest X-ray or CT.

A smooth wave of light from a simple clear tube.
Figure 3.Spirometry measures airflow.

Which symptoms matter?

Breathlessness, a dry cough, wheezing, tiring quickly on stairs and repeated chest infections.

How to protect your lungs

Do not smoke and avoid smoky places, have your vaccines, stay active and protect yourself from dust and chemical fumes.

When to call your doctor

Worrying signs — fever, bleeding, new pain, breathlessness — should be reported to your doctor between visits too. Getting in touch early is always better than waiting.

05Breathing easily

Steps to protect the lungs.

Notice — Pay attention to breathing.1NoticePay attention to breathing.
Test — A lung function test.2TestA lung function test.
Smoke-free — No smoking, no smoke.3Smoke-freeNo smoking, no smoke.
Protection — Flu and pneumococcal vaccines.4ProtectionFlu and pneumococcal vaccines.
LungsFunction is monitored.
ProtectionAway from infection and smoke.
StaminaAn active life.

06Lung risk and checks (simplified)

TreatmentPossible effectCheck
Total body irradiationLung fibrosisSpirometry, diffusion
Busulfan, carmustineLung fibrosisLung function test
Allogeneic transplantBronchiolitis obliteransRegular spirometry
Severe pneumoniaScar tissueX-ray, CT
SmokingRaises all risksStop

* Your doctor sets the testing schedule.

07Key terms

Spirometry
A test of breathing volume and speed.
FEV1
The volume of air blown out in the first second.
Diffusion test
A test of how oxygen passes into the blood.
Fibrosis
Scarring of lung tissue.
Bronchiolitis obliterans
Narrowing of the small airways.
Pneumococcus
A bacterium that is a common cause of pneumonia.

08Key points

  • The lungs are usually normal.
  • Risk depends on treatment.
  • Spirometry after transplant.
  • Report new breathlessness.
  • Do not smoke.
  • Have your vaccines.

09Frequently asked questions

I had no radiation. Do I need a lung test?

Usually not if you have no symptoms; your doctor decides based on your treatment.

Are e-cigarettes safe?

No, they also irritate the lungs; not smoking at all is best.

Can lung GVHD be treated?

Yes, if found early, treatment can help stop loss of function.

Does exercise help the lungs?

Yes, regular movement strengthens breathing muscles and builds stamina.

Does this information replace medical advice?

No. This is general education; only your treating doctor can assess your situation.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. I had no radiation. Do I need a lung test?

  2. Are e-cigarettes safe?

  3. Can lung GVHD be treated?

  4. Does exercise help the lungs?

  5. Does this information replace medical advice?

My questions

12Sources

  1. National Cancer Institute (NCI). Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version
  2. Children's Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers
  3. MedlinePlus (U.S. National Library of Medicine). Bronchiolitis obliterans
  4. Biology of Blood and Marrow Transplantation, 2015. Jagasia MH et al. NIH Consensus Development Project on Criteria for Clinical Trials in Chronic GVHD: 2014 Diagnosis and Staging Working Group Report
  5. MedlinePlus (U.S. National Library of Medicine). Quitting Smoking
  6. National Cancer Institute (NCI). Follow-Up Medical Care
  7. National Cancer Institute (NCI). Cancer Survivorship
  8. Cancer.Net (ASCO). Follow-Up Care After Cancer Treatment
  9. Leukemia & Lymphoma Society (LLS). Long-Term and Late Effects of Treatment
  10. NHS. Walking for health
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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