Medline ® Abstracts for References 2-5
of 'Bleomycin-induced lung injury'
Bleomycin-induced pulmonary toxicity.
Jules-Elysee K, White DA
Clin Chest Med. 1990;11(1):1.
Bleomycin is recognized to cause an interstitial pneumonitis that can lead to fibrosis. Although its occurrence may be sporadic, some factors may increase the risk of such a pulmonary reaction. In this article the clinical setting and presentation, radiographic manifestations, pathologic findings, and the prognosis of bleomycin-induced interstitial fibrosis are described. Additionally, the role of pulmonary function tests in monitoring patients for toxicity is discussed.
Division of Pulmonary Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.
Camus P. Interstitial lung disease from drugs, biologics, and radiation. In: Interstitial Lung Disease, 5th ed, Schwarz MI, King TE Jr (Eds), People's Medical Publishing House, Shelton, CT 2011. p.637.
no abstract available
The cytotoxic agent bleomycin is feared for its induction of sometimes fatal pulmonary toxicity, also known as bleomycin-induced pneumonitis (BIP). The central event in the development of BIP is endothelial damage of the lung vasculature due to bleomycin-induced cytokines and free radicals. Ultimately, BIP can progress in lung fibrosis. The diagnosis is established by a combination of clinical symptoms, radiographic alterations, and pulmonary function test results, while other disorders resembling BIP have to be excluded. Pulmonary function assessments most suitable for detecting BIP are those reflecting lung volumes. The widely used transfer capacity of the lungs for carbon monoxide appeared recently not to be specific when bleomycin is used in a polychemotherapeutic regimen. There are no proven effective treatments for BIP in humans, although corticosteroids are widely applied. When patients survive BIP, they almost always recover completely with normalization of radiographic and pulmonary function abnormalities. This review focuses on BIP, especially on the pathogenesis, risk factors, and its detection.
Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, The Netherlands. firstname.lastname@example.org
Predicting the risk of bleomycin lung toxicity in patients with germ-cell tumours.
O'Sullivan JM, Huddart RA, Norman AR, Nicholls J, Dearnaley DP, Horwich A
Ann Oncol. 2003;14(1):91.
BACKGROUND: Bleomycin pulmonary toxicity (BPT) has been known since the early clinical trials of bleomycin in the 1960s. Postulated risk factors include cumulative bleomycin dose, reduced glomerular filtration rate (GFR), raised creatinine, older age and supplemental oxygen exposure.
PATIENTS AND METHODS: From our prospectively collected testicular cancer research database, we reviewed 835 patients treated at the Royal Marsden NHS Trust (Sutton, UK) with bleomycin-containing regimens for germ-cell tumours between January 1982 and December 1999, to identify those with BPT.
RESULTS: Fifty-seven (6.8%) patients had BPT, ranging from X-ray/CT (computed tomography) changes to dyspnoea. There were eight deaths (1% of patients treated) directly attributed to BPT. The median time from the start of bleomycin administration to documented lung toxicity was 4.2 months (range 1.2-8.2). On multivariate analysis, the factors independently predicting for increased risk of BPT were GFR<80 ml/min [hazard ratio (HR) 3.3], age>40 years (HR 2.3), stage IV disease at presentation (HR 2.6) and cumulative dose of bleomycin>300,000 IU (HR 3.5).
CONCLUSIONS: Patients with poor renal function are at high risk of BPT, especially if they are aged>40 years, have stage IV disease at presentation or receive>300,000 IU of bleomycin. In such cases alternative drug regimens or dose restriction should be considered.
Academic Unit of Radiotherapy and Clinical Oncology, The Institute of Cancer Research, Royal Marsden NHS Trust, Sutton, UK. email@example.com