title: Predicting the risk of bleomycin lung toxicity in patients with germ-cell tumours.
abstract: 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.
  
  
  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.
authors.affiliation: Academic Unit of Radiotherapy and Clinical Oncology, The Institute of Cancer Research, Royal Marsden NHS Trust, Sutton, UK. drjoeosullivan@ireland.com
authors.forename: J M
authors.initials: JM
authors.lastname: O'Sullivan
authors.forename: R A
authors.initials: RA
authors.lastname: Huddart
authors.forename: A R
authors.initials: AR
authors.lastname: Norman
authors.forename: J
authors.initials: J
authors.lastname: Nicholls
authors.forename: D P
authors.initials: DP
authors.lastname: Dearnaley
authors.forename: A
authors.initials: A
authors.lastname: Horwich
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D001761:Bleomycin / Q000009:adverse effects*; D002648:Child; D015331:Cohort Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced; D008171:Lung Diseases / Q000139:chemically induced* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012307:Risk Factors; D018239:Seminoma / Q000188:drug therapy; D013736:Testicular Neoplasms / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000903:Antibiotics, Antineoplastic; D001761:Bleomycin