title: Bleomycin-associated Lung Toxicity in Childhood Cancer Survivors.
abstract: Pulmonary disease is a significant morbidity among childhood cancer survivors. The aim of this study was to characterize the pulmonary dysfunction experienced by childhood cancer survivors treated with bleomycin. A cross-sectional analysis of pulmonary function testing (PFT) in survivors treated with bleomycin was preformed. The most recent posttherapy PFT was assessed. Spirometry and lung volumes were categorized as normal, restrictive, obstructive, or mixed. Diffusing capacity of carbon monoxide (DLCO) was categorized as normal or abnormal. PFT data of 143 survivors was analyzed. PFTs were performed a median of 2.3 years (interquartile range, 1.4 to 4.9) from completion of therapy. Spirometry was abnormal in 58 (41%), only 5 (9%) had respiratory symptoms. Forty-two (70%) had obstructive, 11 (18%) restrictive, and 5 (9%) mixed ventilatory defects. The majority of abnormalities were mild (91%). DLCO was abnormal in 27. Reductions were mild in 96%. Patients with a history of relapse were more likely to develop abnormalities in spirometry and/or DLCO (odds ratio=5.02, 95% confidence interval: 1.3-19.4, P=0.01; odds ratio=3.47, 95% confidence interval: 1.01-11.9, P=0.03). Asymptomatic abnormalities of PFT are common among childhood cancer survivors treated with bleomycin and associated with a history of relapse. Research studying the risk for clinical progression of this dysfunction is warranted.
authors.affiliation: *Children's Hospital, Department of Pediatrics, Division of Hematology/Oncology, Western University, London Departments of ‡Pediatrics, Division of Respiratory Medicine §Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON †BC Children's Hospital, Department of Pediatrics, Division of Respirology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Alexandra P
authors.initials: AP
authors.lastname: Zorzi
authors.forename: Connie L
authors.initials: CL
authors.lastname: Yang
authors.forename: Sharon
authors.initials: S
authors.lastname: Dell
authors.forename: Paul C
authors.initials: PC
authors.lastname: Nathan
mesh_terms: D000293:Adolescent; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001249:Asthma / Q000150:complications; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006689:Hodgkin Disease / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008171:Lung Diseases / Q000139:chemically induced* / Q000473:pathology / Q000503:physiopathology; D008176:Lung Volume Measurements; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D009373:Neoplasms, Germ Cell and Embryonal / Q000150:complications / Q000188:drug therapy; D011653:Pulmonary Diffusing Capacity; D012189:Retrospective Studies; D013147:Spirometry; D017741:Survivors
chemical_list: D000903:Antibiotics, Antineoplastic; D001761:Bleomycin