Pulmonary Toxicity of Bleomycin - A Case Series from a Tertiary Care Center in Southern India (original) (raw)
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Bleomycin pulmonary toxicity does not adversely affect the outcome of patients with Hodgkin lymphoma
Leukemia & lymphoma, 2017
Bleomycin pulmonary toxicity (BPT) is a well-described complication of bleomycin-containing regimens. Previous data on risk factors and the impact of BPT on survival in Hodgkin lymphoma (HL) were conflicting. We reviewed 253 HL patients treated with adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) at the Princess Margaret Hospital from 1999 to 2009 to examine the incidence and risk factors for BPT, and the effect of BPT on survival. BPT was defined by pulmonary symptoms, bilateral interstitial infiltrates on computed tomography, and the absence of infection. Kaplan-Meier estimates were used to compare overall survival (OS) and progression-free survival (PFS) between groups. The incidence of BPT was low (11%). Age ≥45 (OR = 2.5) and granulocyte colony-stimulating factor use (OR = 3.6) were identified as predictors of BPT on multivariable logistic models. At a follow-up of 5 years, OS and PFS were 88% and 82%, respectively. Neither BPT nor bleomycin discontinuation had significa...
Late pulmonary complications of treating Hodgkin lymphoma: bleomycin-induced toxicity
Expert Opinion on Drug Safety, 2014
Introduction: Survival of Hodgkin lymphoma (HL) patients has significantly improved in recent decades. The current first-line therapy is doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) ± irradiation and may cause pulmonary toxicity. Strategies to reduce late toxicity as well as increase survival rate are of interest. Patients and methods: Pulmonary function of previously treated HL patients was collected over a 12-month period using St. George Respiratory Questionnaire (SGRQ), chest X-ray, dynamic inhalation lung scintigraphy and spirometry. Results: A total of 137 patients' data were reviewed. Median time elapsed since diagnosis was 11 years (range was 2 --30 years). Chest irradiation did not significantly worsen pulmonary function. Number of ABVD cycles with consequential bleomycin dose showed significant correlation with SGRQ total score in patients receiving ABVD plus chest irradiation (p = 0.01). Scintigraphy results correlated with bleomycin dose in patients receiving ABVD without chest irradiation (right side: p = 0.099, left side: p = 0.051). Discussion: An additive negative effect of chest irradiation was not confirmed as reflected in the literature; however, increasing cumulative bleomycin dose worsened pulmonary function.
A case of bleomycin-induced lung toxicity
Monaldi Archives for Chest Disease, 2018
A 64-year-old female was admitted for dry cough, dyspnea, fever, loss of appetite, and weight loss. Past medical history revealed scoliosis, cholecystectomy, and Hodgkin lymphoma. ABG values were: pH: 7.42, pCO2: 40.2 mm Hg, pO2: 61.4 mm Hg. Chest CT showed cystic lesions, emphysema, ground glass, and reticular opacities. ABG values worsened under 8L/min nasal oxygen. The patient underwent bilevel positive airway pressure (BiPAP) and methylprednisolone 60 mg/day bid was commenced. The final diagnosis was respiratory insufficiency due to bleomycin toxicity. The patient deceased on the sixth day after transfer to the intensive care unit. Bleomycin is an effective chemotherapeutic agent used for Hodgkin lymphoma treatment. It causes significant lung toxicity in half of the patients. Clinicians should always remember that bleomycin toxicity may lead to fatal complications in patients with comorbid conditions. We present this case to remark the possible consequences of bleomycin toxicity...
Leukemia & Lymphoma, 2018
In Hodgkin lymphoma (HL) bleomycin can induce pulmonary toxicity (BPT). BPT consists of respiratory tract symptoms during bleomycin-exposure and radiologic pulmonary lesions without concomitant infection. Older age, bleomycin dose, smoking history and the use of granulocyte-colony stimulating factor (G-CSF) have been suggested as possible risk factors for BPT. It is still debated whether BPT affects overall (OS) and progression-free survival (PFS). We investigated the incidence of BPT along with possible risk factors in 412 HL patients treated in 1990-2014. BPT occurred in 34 patients (8%) and was significantly associated with disseminated disease and B-symptoms. It was more frequent in elderly patients (p ¼ .05) but not significantly correlated with a history of smoking. BPT occurred more often in patients receiving G-CSF (p ¼ .03), particularly the poly-ethylenglycol-bound molecule. All significant risk correlations were limited to the age group >45 years. In the present cohort, BPT did not influence OS or PFS regardless of age.
Cureus
Introduction Bleomycin is a major antimitotic agent in the first-line treatment for Hodgkin's lymphoma. The main limitation of its use is its pulmonary toxicity. The objectives of this study are to find out the risk factors for the occurrence of bleomycin-induced lung toxicity in patients with Hodgkin's lymphoma and, on the other hand, to determine if positron emission tomography scan is a reliable means of early detection of this toxicity.
Bleomycin lung toxicity: who are the patients with increased risk?
Pulmonary Pharmacology & Therapeutics, 2005
Bleomycin is an antibiotic drug with anticancer properties produced by Streptomyces verticillus [Cheson BD. The complex bleomycin-Fe has been the most studied because bleomycin joins the DNA and Fe at the same time, and release of free radicals happens in the presence of molecular oxygen [Hay J, Shahzeidi S, Laurent G. Mechanisms of bleomycin-induced lung damage. Arch Toxicol 1991;65:81-94].
Pulmonary Toxicity of Hodgkin Lymphoma Treatment: A Prospective Single-Center Study
Journal of Hematology, 2021
Background Standard bleomycin-containing first-line therapy and/or irradiation may cause pulmonary toxicity in Hodgkin lymphoma (HL) patients. Our aim was to prospectively assess effects of chest irradiation, bleomycin administration, and other factors on lung function in the treatment of patients with HL. Methods Pulmonary function of newly diagnosed HL patients was assessed via a St. George Respiratory Questionnaire, dynamic inhalation lung scintigraphy, spirometry, and an assessment of the diffusion capacity of the lung for carbon monoxide (DLCO) before, during, and after treatment. Results This prospective study was conducted at the University of Debrecen. The study included 84 patients with classical HL. Most patients received standard doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy. Both intramuscular and intravenous administrations of bleomycin were used. Brentuximab vedotin combination chemotherapy was administered to 12 patients. Mediastinal involved-field...
Clinical trials with bleomycin in lymphomas and in solid tumors
European Journal of Cancer (1965), 1972
The authors report the results of Phase I and Phase H evaluation of intravenous bleomycin (BLM) in 176 patients. During the trial different doses and schedules were employed. The less toxic regimen was that of 15 mg/m 2 x 2]week per 4 weeks. Irrespective of the schedules, the side effects are represented by sclerotic changes of the skin of hands (88%), skin hyperpigmentation (78%),fever (70%), loss of hair (68%), stomatitis (47%) pulmonary toxicity (42%), gastro-intestinal symptoms (20 %). No significant myelo-suppression was observed. Pulmonary toxicity occurred after 4-10 weeks from starting therapy and was detected on clinical bases (fine crepitations at the base), radiologically (reticulonodularity mostly at the lower lung zones) and histologically (edema of alveoli, hyaline membranes formation, collagen deposition). Upon prompt discontinuation of BLM, the signs of pulmonary damage remained unchanged or regressed in the majority of cases. Lower total doses of BLM produced a lesser incidence of lung toxicity. However, in about 5 % of cases the presumptive cause of death could be related to extensive pulmonary drug-induced lesions. The incidence of lung toxicity was not found to be significantly related to the age of patients, to the total dose of BLM or to the presence of chronic pulmonary disease. BLM produced significant regression in all types of malignant lymphomas (40%), in epidermoid carcinomas of the head and neck (57%) and of the esophagus (60%). No significant responses were observed in epidermoid carcinomas of the lung. Regressions were prompt but usually short-lived with or without maintenance therapy. Because of its toxic and therapeutiv properties BLM appears suitable for therapeutictrials eitherinshort courses alone in or in combination with myelosuppressive agents.
Incidence, outcomes and predictors of bleomycin pulmonary toxicity in a university hospital in Oman
Journal of Oncology Pharmacy Practice
Objectives: To determine the incidence and predictors of bleomycin pulmonary toxicity in a university hospital in Oman. Methods: This retrospective chart review consisted of 46 patients treated with bleomycin-containing regimes at Sultan Qaboos University Hospital in Oman between January 2007 and December 2010. Data regarding patient age, chemotherapy protocol, cumulative bleomycin dose, smoking history, renal function and concurrent use of granulocyte colony stimulating factor (GCSF) were collected from the hospital’s electronic database. Analyses were performed using univariate statistical techniques. Results: Of the 46 patients, 22% (n¼10) experienced bleomycin pulmonary toxicity. There was an overall mortality of 4.3% (n¼2; N¼46), with significantly more deaths in the bleomycin pulmonary toxicity group compared to the cohort that did not have bleomycin pulmonary toxicity (20% versus 0%; p¼0.043). The bleomycin pulmonary toxicity group was significantly older compared to the coho...
Journal of Clinical Oncology, 2011
Bleomycin-induced pneumonitis (BIP) is a scarcely manageable pulmonary toxicity that occurs in approximately 20% of patients who are affected with cancers that are treated with bleomycin-containing regimens. Generally, the clinical picture is extremely complicated and therapy is based on steroids. The overall response rate to such therapy is limited. Recent insights in BIP pathogenesis have indicated that a key feature is deregulated mechanisms of tissue repair that are driven by profibrotic cytokines. Here we describe a patient with lifethreatening BIP who was completely cured with imatinib mesylate (IM) after steroids and all other therapies had failed. Case Report A 65-year-old man with stage IV Hodgkin's lymphoma (HL; lymphocyte-depleted variant), already in metabolic complete response after a third cycle of doxorubicin, 50 mg/m 2 ; bleomycin, 10 U/m 2 ; vinblastine, 6 mg/m 2 ; and dacarbazine, 375 mg/m 2 , presented with progressive shortness of breath, fever, and dry cough 3 weeks after completion of the sixth cycle of therapy. His medical history was unremarkable. On examination, the patient demonstrated a Karnofsky performance status of 50%, body temperature of 38°C, blood pressure of 120/70 mm Hg, pulse rate of 104 beats/min, and respiratory rate of 28 breaths/min. Oxygen saturation was 83% at room air and 93% with a 60% mist mask; arterial blood gases showed pH, 7.47; PaO 2 , 64 mm Hg; PCO 2 , 27 mm Hg; bicarbonate, 22 mmol/L; and arterial lactate, 2.6 mmol/L. On auscultation, there were crackles and crepitations across the lower and middle lung fields.