Successful treatment of bleomycin lung

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Bleomycin sulfate is an antitumor antibiotic with clinical activity against Hodgkin’s and non-Hodgkin’s lymphoma; squamous cell carcinoma of the head and neck, esophagus, cervix, penis, and skin; and carcinoma of the testis.1

The major dose-limiting toxicity of bleomycin is pulmonary fibrosis.1 Factors influencing development of this serious side effect include age, cumulative dose,1 and prior radiation therapy to the chest.2 Although pulmonary fibrosis will develop in less than 10% of patients receiving bleomycin,1, 3 treatment of this complication is generally unsuccessful. Some authors have pointed out that early diagnosis and subsequent withdrawal of the drug may prevent progression to fibrosis,4, 5 but in most series the irreversible nature of symptomatic bleomycin pulmonary toxicity has been emphasized.1, 2 Corticosteroid therapy in particular has been disappointing, with only anecdotal mention of responding patients. We have studied two patients with severe bleomycin pulmonary toxicity who recovered after steroid therapy.

Case reports

Case 1. A 52-year-old white man with stage III chorio-carcinoma of the testis with involvement of the supra-clavicular, mediastinal, and retroperitoneal nodes was treated with cis-platinum, vinblastine sulfate, and bleomycin chemotherapy. He received 360 mg of bleomycin (180 mg/m2) for 8 weeks. When the bleomycin was withdrawn, the chest roentgenogram revealed new linear infiltrates in both lung fields. He was asymptomatic and no rales were heard on auscultation. Fourteen weeks later severe dyspnea at rest developed requiring supplemental oxygen therapy. He was afebrile and all cultures were negative.

Open lung biopsy revealed interstitial pneumonitis with fibrosis and focal desquamation. Stain for . . .



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