title: Safety and efficacy of bleomycin sclerotherapy for microcystic lymphatic malformation.
abstract: OBJECTIVE
  Sclerotherapy is the mainstay of treatment of macrocystic lymphatic malformation (LM), but the response using traditional sclerosants is much less beneficial in microcystic lesions. Intralesional bleomycin has been reported to be effective in microcystic LM; however, its use is limited by concerns about pulmonary fibrosis. The purpose of this study was to evaluate the safety and efficacy of bleomycin sclerotherapy in microcystic LM.
  
  
  METHODS
  The medical records and imaging studies of all patients with microcystic or combined LM who underwent percutaneous image-guided sclerotherapy using bleomycin were retrospectively reviewed. Only patients with pre- and postprocedure imaging were included. Thirty-one patients with a mean age of 13.4 years (range 3 months-31 years) were treated. Response was graded as complete (>90% size reduction), partial (25-90%), or minimal/no response (<25%). Pulmonary function tests (PFT) and chest X-rays were performed before the procedure. PFT were repeated at 6 months and 1 year postprocedure. Annual postprocedure chest X-rays were also performed.
  
  
  RESULTS
  The malformations were located in the head and neck (n = 27) and trunk (n = 4). The number of procedures ranged from 1 to 4 (mean 1.7). Up to 1 U/kg of bleomycin was injected per session, with a maximum of 15 U. The mean follow-up period was 3.2 years (range 1.5-5 years). There was complete response in 38% (n = 12), partial response in 58% (n = 18), and no response in 3% (n = 1). No complications were identified.
  
  
  CONCLUSIONS
  Preliminary indicate that sclerotherapy of microcystic LMs using bleomycin is effective and safe.
authors.affiliation: Vascular Anomalies Center, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA, gulraiz.chaudry@childrens.harvard.edu.
authors.forename: Gulraiz
authors.initials: G
authors.lastname: Chaudry
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Guevara
authors.forename: Kristy L
authors.initials: KL
authors.lastname: Rialon
authors.forename: Cindy
authors.initials: C
authors.lastname: Kerr
authors.forename: John B
authors.initials: JB
authors.lastname: Mulliken
authors.forename: Arin K
authors.initials: AK
authors.lastname: Greene
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Fishman
authors.forename: Debra
authors.initials: D
authors.lastname: Boyer
authors.forename: Ahmad I
authors.initials: AI
authors.lastname: Alomari
mesh_terms: D000293:Adolescent; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D001761:Bleomycin / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D044148:Lymphatic Abnormalities / Q000188:drug therapy*; D008297:Male; D013902:Radiography, Thoracic; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D015911:Sclerotherapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000903:Antibiotics, Antineoplastic; D001761:Bleomycin