Older patients and risk of developing and dying from bleomycin-induced lung toxicity.

Abstract

8584 Background: Bleomycin-induced pneumonitis (BIP) has been well described in classical Hodgkin lymphoma (cHL) patients treated with bleomycin-containing chemotherapy regimens. The incidence of acute and subacute pulmonary toxicity varies widely and multiple factors contribute to mortality in patients with BIP. We therefore reviewed the outcome of cHL patients treated at a single institution to further define the incidence of BIP and to identify major contributors to BIP-associated morbidity and mortality. Methods: One hundred sixty-one pediatric and adult patients who were treated with bleomycin-containing chemotherapy for newly diagnosed cHL between January 2000 and December 2012 were eligible for this retrospective review. BIP was defined by fever, pulmonary symptoms, pulmonary infiltrates, or a decline in DLCO, with no evidence of an infectious etiology. Results: BIP was observed in 43.5 % (n=70) of patients. Age >/=45 years was associated with both an increased incidence (p= <0.0001) and increased severity (p=0.0005) of lung toxicity. ABVD regimen as initial therapy (p= <0.001), obesity (p=0.0331) and the presence of at least one cardiac or respiratory comorbidity (p=0.0088) was also associated with the development of BIP. Higher BMI was associated with earlier onset of lung toxicity. No significant increase in pulmonary toxicity was noted with co-administration of G-CSF (p=0.7249). Bleomycin related mortality rate was 4.97 % (n=8) when all patients were considered and 11.43 % (8/70) in patients who developed pulmonary symptoms. Seventy five percent (6/8) of those who died were older than 60 years. Conclusions: The risk of BIP is significant in cHL with the use of bleomycin-containing regimens. Age >/= 45 years appears to increase the risk of BIP and is associated with increased mortality. These findings highlight the need for testing novel treatment combinations in cHL patients that omit bleomycin.