title: Bleomycin pulmonary toxicity has a negative impact on the outcome of patients with Hodgkin's lymphoma.
abstract: OBJECTIVE
  Bleomycin pulmonary toxicity (BPT) has been well described in Hodgkin's lymphoma (HL) patients treated with bleomycin-containing chemotherapy regimens. The influence of this pulmonary complication, along with the omission of bleomycin from further chemotherapy, on overall survival (OS) and progression-free survival (PFS) in HL remains unclear. We reviewed our experience with BPT in HL to better delineate outcome and appropriate treatment in these patients.
  
  
  METHODS
  One hundred forty-one patients who were treated with bleomycin-containing chemotherapy for newly diagnosed HL between January 1986 and February 2003 were eligible for this retrospective review. BPT was defined by the presence of pulmonary symptoms, bilateral interstitial infiltrates, and no evidence of an infectious etiology.
  
  
  RESULTS
  BPT was observed in 18% of patients. Increasing age, doxorubicin, bleomycin, vinblastine, and dacarbazine as initial therapy, and granulocyte colony-stimulating factor use were associated with the development of BPT. Patients with BPT had a median 5-year OS rate of 63% v 90% (P = .001) in unaffected patients. The mortality rate from BPT was 4.2% in all patients and 24% in patients who developed the pulmonary syndrome. BPT incidence and mortality were highest in patients older than 40 years. The omission of bleomycin had no impact on obtaining a complete remission, PFS, or OS.
  
  
  CONCLUSIONS
  BPT results in a significant decrease in 5-year OS in patients who are treated for HL. Age > or = 40 years seems to add substantially to the risk. In patients who do not die from acute pulmonary toxicity, both OS and PFS seem equal, despite the omission of bleomycin.
authors.affiliation: Division of Hematology and Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: William G
authors.initials: WG
authors.lastname: Martin
authors.forename: Kay M
authors.initials: KM
authors.lastname: Ristow
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Habermann
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Colgan
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Witzig
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Ansell
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin; D002648:Child; D003606:Dacarbazine; D004317:Doxorubicin; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor; D006689:Hodgkin Disease / Q000188:drug therapy*; D006801:Humans; D008171:Lung Diseases / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014747:Vinblastine
chemical_list: D001761:Bleomycin; D016179:Granulocyte Colony-Stimulating Factor; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin