Leukemia and its treatments may lead to health problems called complications or sequelae. One such complication is pulmonary (lung) damage.

Some of the most common lung-related complications of leukemia include:

• Pneumonia — An infection of the air sacs within the lungs
• Pulmonary hemorrhage — Bleeding in the lungs
• Pulmonary edema — Fluid in the lungs
• Pulmonary leukostasis — Leukemia cells growing in the blood vessels and tissues of the lungs

Causes and Risk Factors

Some lung complications are directly caused by leukemia cells. Others are caused by lung cancer treatments. In particular, chemotherapy and stem cell transplantation may cause toxicity and damage, leading to lung problems. Newer treatments like targeted therapies also sometimes affect the lungs.

How Does Leukemia Lead To Lung Problems?

Leukemia cells travel through the blood, affecting organs and tissues around the body. There are several ways in which leukemia can have an impact on the lungs.

During leukemia, cancer cells crowd out normal blood cells in the bone marrow (the spongy tissue found inside certain bones). People with leukemia may have high numbers of abnormal blood cells, but often have low levels of healthy white blood cells (WBCs) like neutrophils that help fight infection. Having low neutrophil counts is called neutropenia. People with this condition have a higher risk of developing different types of infections — for example, pneumonia that affects the lungs.

People with very high levels of WBCs may develop pulmonary leukostasis. This problem is most common in individuals with acute myelomonocytic leukemia, a type of acute myeloid leukemia. When a person has extremely high white blood cell counts, all of these extra leukemia cells may fill up small blood vessels in the lungs, blocking them. Chronic myeloid leukemia can also cause leukostasis, but this is rare.

Leukemia also leads to pulmonary leukemic infiltration. During this condition, leukemic cells spread to other tissues within the lungs. Pulmonary leukemic infiltration and pulmonary leukostasis can lead to acute respiratory failure, in which the lungs can’t get enough oxygen into the blood. A related condition, acute respiratory distress syndrome, sometimes develops in people with acute myeloid leukemia. It occurs when the lungs become very inflamed for a short amount of time. Acute respiratory failure and acute respiratory distress syndrome can be serious and require emergency medical care.

Chronic lymphocytic leukemia can also cause swelling of the lymph nodes. Lymph nodes are a part of the lymphatic system, which is responsible for filtering out germs, removing waste, and controlling levels of fluid within the body. Enlarged lymph nodes can press on blood vessels or lymph vessels in the lungs. This may prevent fluid from draining and lead to pleural effusion.

Lung Problems During Leukemia Induction Therapy

Treatments for acute leukemia are divided into phases. The first phase, which aims to get rid of as many leukemia cells as possible, is called induction therapy. This is often followed by consolidation therapy, which helps keep cancer away.

Nearly half of people experience lung problems during induction chemotherapy. These include complications like pulmonary edema and lung infections. Chemotherapy drugs can suppress the immune system and make it harder for the body to fight off bacteria, viruses, and fungus.

People who smoke cigarettes or had previous lung diseases are more likely to experience lung problems during chemotherapy.

Stem Cell Transplantation and Lung Complications

Some people with leukemia undergo a procedure called a stem cell transplant. Stem cells are cells within the bone marrow that make blood cells. During a stem cell transplant, a person receives high doses of chemotherapy or radiation therapy to kill leukemia cells. This aggressive treatment also damages the stem cells, so doctors then give the person an infusion of new stem cells to replace the ones that were lost. These cells can be from the person with leukemia (that were collected and stored before high-dose therapy) or come from a donor.

People who receive stem cell transplants are at risk for developing infections. These infections tend to occur within a few months of undergoing a transplant before the immune system returns to normal.

About 1 out of 5 people who undergo a stem cell transplant develop pulmonary hemorrhage. Additionally, some people develop pulmonary edema. Stem cell transplants can also damage the cells of the lungs, causing them to not work as well. When these complications occur, they most often develop within the first few weeks after transplantation.

Targeted Therapies and Lung Problems

Most people with chronic myeloid leukemia take targeted therapy drugs called tyrosine kinase inhibitors. These include Gleevec (imatinib), Tasigna (nilotinib), Sprycel (dasatinib), Bosulif (bosutinib), and Iclusig (ponatinib).

Targeted therapies usually have fewer and milder side effects compared to chemotherapy. However, they sometimes lead to immunologically caused problems, including lung complications. People who use tyrosine kinase inhibitors are at risk for:

• Pleural effusion — Sometimes referred to as "water on the lungs"
• Pulmonary hypertension — High blood pressure in the blood vessels of the lungs
• Interstitial lung disease — Disorders that cause scarring within lung tissue and prevent the lungs from expanding properly
• Pneumonia — Infection of the lungs

Living With Leukemia and Lung Complications

If you have leukemia, be aware of possible symptoms of lung problems. Ask your doctor if there is anything in particular you should watch out for. Tell your health care team right away if you notice any changes to your breathing or feel any new sensations in your chest. Potential symptoms include:

• Shortness of breath
• Fast breathing
• Wheezing
• A new cough
• Coughing up blood
• Fever
• Having your skin or nails turn a bluish color
• Feeling like you’re drowning or suffocating
• Pale or clammy skin
• Chest pain

Occasionally, these problems are side effects of leukemia treatments. For example, chemotherapy or radiation therapy may lead to coughing or shortness of breath. Your doctor can help you understand what is causing any new health changes and learn how to manage them.

Doctors use several different tests and procedures to diagnose lung complications. These may include:

• Bronchoscopy — Doctors use a thin tube with a camera on the end to look inside the lungs.
• Bronchoalveolar lavage — During this procedure, doctors wash the airways with saline and then collect the fluid for further testing.
• Lung biopsy — A procedure in which doctors take a small sample of lung cells so they can be examined under a microscope.
• CT scan — This imaging test is used to see inside the lungs more clearly.

Some pulmonary problems are serious and may require emergency medical care or a stay in an intensive care unit. Developing lung complications during induction chemotherapy leads to lower survival rates. In particular, infections are a common cause of death for people with leukemia.

Managing Lung Problems

Infections like pneumonia may be treated with different medications. For example, if an infection is caused by bacteria, antibiotics can help. Drugs like Advil (ibuprofen) or Tylenol (acetaminophen) can help relieve pain and fevers. However, people on chemotherapy should only take these drugs under the advice of their doctor.

Treatment for pulmonary leukostasis involves addressing the very high numbers of WBCs. To do this, doctors may recommend leukapheresis, a process in which a machine filters and removes WBCs from the blood. Chemotherapy drugs can also help get rid of extra cells.

When problems like pulmonary edema make it hard to breathe, doctors may provide supplemental oxygen. A person with lung complications may need to wear a face mask or nasal cannula (a small, flexible tube that contains two open prongs that sit just inside your nostrils) that helps increase the amount of oxygen breathed in. Diuretic medications can help remove extra fluid.

If you are experiencing mild lung problems, certain strategies may help relieve symptoms. Make sure to get enough sleep and drink a lot of fluids. Avoid smoking, or being around secondhand smoke or campfires. You can also use steam to help open your airways by taking a hot shower, drinking a cup of hot tea, or using a humidifier. However, people with leukemia should always let their doctor know when they notice any breathing abnormalities or other potential respiratory symptoms.

Talk With Others Who Understand

MyLeukemiaTeam is the social network for people with leukemia. On MyLeukemiaTeam, more than 10,000 members come together to ask questions, give advice, and share their stories with others who understand life with leukemia.

Are you living with leukemia? Have you experienced any lung issues? Share your experiences in the comments below, or start a conversation by posting on your Activities page.