Bleomycin lung toxicity is an uncommon but recognized complication that can occur with the chemotherapeutic drug bleomycin.
Bleomycin is an antitumour antibiotic which was initially isolated from a strain of Streptomyces verticillus in 1966. It is commonly used (either alone or in combination with other chemotherapeutic agents) in the treatment of squamous cell carcinomas (of the head and neck, cervix, and vagina), testicular cancer, and Hodgkin lymphoma.
Bleomycin-induced lung injury usually occurs in 3-18% of treated patients (this figure will vary dependent on detection method used), although there is a marked increased risk if the total cumulative dose is more than 450 units.
The risk of developing lung injury is increased in the elderly and in patients receiving oxygen therapy, with a history of prior thoracic irradiation, or in whom therapy is re-instituted within 6 months of discontinuation.
On HRCT chest it can manifest in several patterns that include:
- diffuse alveolar damage
- pulmonary fibrosis
- organizing pneumonia pattern
- NSIP pattern
bronchiolitis obliterans organizing pneumonia pattern
- may present as nodules which range from 5 mm to 3 cm in diameter 1
- are usually subpleural in location, and can be sharply or poorly marginated
Treatment and prognosis
The prognosis is poor, with most patients dying of respiratory failure within 3 months of onset of symptoms.
- 1. Rossi SE, Erasmus JJ, Mcadams HP et-al. Pulmonary drug toxicity: radiologic and pathologic manifestations. Radiographics. 20 (5): 1245-59. Radiographics (full text) - Pubmed citation
- 2. Usman M, Faruqui ZS, ud Din N et-al. Bleomycin induced pulmonary toxicity in patients with germ cell tumours. J Ayub Med Coll Abbottabad. 2012;22 (3): 35-7. Pubmed citation
- 3. Martin WG, Ristow KM, Habermann TM et-al. Bleomycin pulmonary toxicity has a negative impact on the outcome of patients with Hodgkin's lymphoma. J. Clin. Oncol. 2005;23 (30): 7614-20. doi:10.1200/JCO.2005.02.7243 - Pubmed citation
- 4. Bellamy EA, Husband JE, Blaquiere RM et-al. Bleomycin-related lung damage: CT evidence. Radiology. 1985;156 (1): 155-8. doi:10.1148/radiology.156.1.2408293 - Pubmed citation
- 5. O'Sullivan JM, Huddart RA, Norman AR et-al. Predicting the risk of bleomycin lung toxicity in patients with germ-cell tumours. Ann. Oncol. 2003;14 (1): 91-6. doi:10.1093/annonc/mdg020 - Pubmed citation
- 6. Rimmer MJ, Dixon AK, Flower CD et-al. Bleomycin lung: computed tomographic observations. Br J Radiol. 1987;58 (695): 1041-5. Pubmed citation
- 7. Bellamy EA, Nicholas D, Husband JE. Quantitative assessment of lung damage due to bleomycin using computed tomography. Br J Radiol. 1988;60 (720): 1205-9. Pubmed citation
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Interstitial lung disease
interstitial lung disease
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idiopathic interstitial pneumonia (mnemonic)
- acute interstitial pneumonia (AIP)
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- desquamative interstitial pneumonia (DIP)
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