title: Does Bleomycin Lung Toxicity Increase the Risk of Radiation Pneumonitis in Hodgkin Lymphoma?
abstract: Bleomycin pulmonary toxicity (BPT) is a well-known complication of treatment in patients with Hodgkin lymphoma (HL). We undertook the present study to investigate the risk of radiation pneumonitis (RP) in the setting of BPT and to determine the need for delay or omission of radiation therapy (RT) in these patients.
  
  
  
  We identified 123 HL patients treated with ABVD (Adriamycin, bleomycin, vinblastine, dacarbazine) followed by RT to the chest from January 2009 to December 2014. The medical records were reviewed for clinical, pathologic, and treatment information and toxicities. Our primary outcome was RP of any grade. Univariate and multivariate analyses were used to assess the association of BPT, baseline patient characteristics, and treatment variables with the incidence of RP.
  
  
  
  A total of 123 patients were included, of whom 99 (80%) received consolidation intensity modulated RT after ABVD treatment. We identified 31 patients (25.2%) with BPT after frontline ABVD. Seventeen patients (13.8%) developed RP a median of 8 weeks (range 1-39) after RT completion. BPT did not correlate with the risk of developing RP (P=.36). We evaluated the RP outcomes with respect to the bleomycin to RT interval (≤6 weeks vs >6 weeks), and we found that this interval did not predict for RP risk (P=.60). Dosimetric parameters such as the volume covered by 5 Gy and the mean lung dose were analyzed. A volume covered by 5 Gy of >55% and mean lung dose >13.5 Gy increased the risk of RP by 1.14-fold (P=.002) and 4.24-fold (P=.007), respectively.
  
  
  
  The results of our study suggest that BPT does not increase the risk of developing RP. Furthermore, RT initiation does not need to be delayed after chemotherapy, except to allow for the completion of steroid therapy or clinical recovery from BPT.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Zeinab
authors.initials: Z
authors.lastname: Abou Yehia
authors.affiliation: Department of Clinical Oncology, Guy's & St Thomas' Hospital, London, United Kingdom.
authors.forename: George N
authors.initials: GN
authors.lastname: Mikhaeel
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Grace
authors.initials: G
authors.lastname: Smith
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Chelsea C
authors.initials: CC
authors.lastname: Pinnix
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Milgrom
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Chad
authors.initials: C
authors.lastname: Tang
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Wen
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Fanale
authors.affiliation: Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Oki
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: JoAnn H
authors.initials: JH
authors.lastname: Shank
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Trisha
authors.initials: T
authors.lastname: Horace
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jay
authors.initials: J
authors.lastname: Reddy
authors.affiliation: Department of Radiation Oncology, The University of Texas Medical Branch Hospitals, Galveston, Texas.
authors.forename: Mani
authors.initials: M
authors.lastname: Akhtari
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jillian R
authors.initials: JR
authors.lastname: Gunther
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Tina
authors.initials: T
authors.lastname: Suki
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Allen
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Shryll
authors.initials: S
authors.lastname: Turner
authors.affiliation: Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Osama
authors.initials: O
authors.lastname: Mawlawi
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: bdabaja@mdanderson.org.
authors.forename: Bouthaina S
authors.initials: BS
authors.lastname: Dabaja
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects*; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D003606:Dacarbazine / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D015994:Incidence; D008168:Lung / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D017564:Radiation Pneumonitis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods; D013997:Time Factors; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000903:Antibiotics, Antineoplastic; D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin