Is cryptogenic organizing pneumonia (COP) associated with lymphoma treatment?

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Last updated: February 13, 2025 • View editorial policy

From the Guidelines

Yes, cryptogenic organizing pneumonia (COP) is associated with lymphoma treatment, as it is one of the radiological patterns of immune-related interstitial lung disease (IR-ILD) that can occur in patients receiving immunotherapy, including those with lymphoma 1.

Key Points

  • The radiological patterns of IR-ILD have been classified into five possible subtypes, including cryptogenic organising pneumonia-like 1.
  • Immunotherapy has been linked to an increased risk of pneumonitis, with a higher incidence in patients receiving combination therapy compared to monotherapy 2.
  • The incidence of pneumonitis in patients receiving anti-PD-1/PD-L1 monotherapy or in combination with anti-CTLA4 has been reported to be around 4.6%, with a median time to onset of 2.8 months 2.
  • COP is one of the histopathological findings that have been reported in patients with IR-ILD, along with cellular interstitial pneumonitis, organising pneumonia, and diffuse alveolar damage 1.
  • The management of IR-ILD, including COP, typically involves drug withholding and immunosuppression, with most cases improving or resolving with treatment 2.

From the Research

Association between Cryptogenic Organizing Pneumonia (COP) and Lymphoma Treatment

  • There is evidence to suggest that COP can be associated with lymphoma treatment, as some cases of lymphoma can manifest with pulmonary symptoms resembling COP 3.
  • A study found that marginal zone lymphoma (MZL) can present insidiously, masquerading as COP, and that whole-body (18F) fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) can be useful in staging extranodal MZL 3.
  • Another study analyzed bronchoalveolar lavage fluid from patients with COP and lung malignancies, including lymphomas, and found distinct T cell immunophenotypes between the two groups, which could serve as potential diagnostic biomarkers 4.
  • However, other studies suggest that the clinical and radiographic findings in patients with COP and secondary OP, including those associated with lymphoma, are similar and nonspecific 5, 6, 7.
  • It is worth noting that secondary organizing pneumonia can be caused by various factors, including malignancies, and that COP can be distinguished from secondary OP by the absence of an identifiable underlying cause 6, 7.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.