title: Use of fluorodeoxyglucose positron emission tomography for diagnosis of bleomycin-induced pneumonitis in Hodgkin lymphoma.
abstract: Bleomycin is an antineoplastic agent causing fatal pulmonary toxicity. Early diagnosis of bleomycin-induced pneumonitis is crucial to prevent irreversible damage. Pulmonary function tests are unreliable for identifying risk of bleomycin toxicity. Fluorodeoxyglucose PET/CT scanning can reveal inflammation secondary to pneumonitis but is not sufficiently specific for diagnosis. We retrospectively analyzed scans from 77 patients with Hodgkin lymphoma (median age 41 years, mean bleomycin dose 134 mg) to evaluate bleomycin-induced pneumonitis. We identified 13 patients with abnormal lung uptake of fluorodeoxyglucose. Tracer activity was predominantly diffuse, bilateral, in the lower lobes and subpleural areas. Interim scanning during treatment revealed pneumonitis in eight of 13 patients (asymptomatic in six). One asymptomatic patient died of bleomycin toxicity. For remaining 12 patients, bleomycin was discontinued and methylprednisolone given, all showed resolution of the pneumonitis. These findings suggest that routine interim or end-of-treatment FDG-PET/CT scanning could be beneficial for alerting clinicians to asymptomatic bleomycin-induced toxicity.
authors.affiliation: a Koç University, School of Medicine , Department of Nuclear Medicine and Molecular Imaging , Istanbul , Turkey.
authors.forename: Okan
authors.initials: O
authors.lastname: Falay
authors.affiliation: b Koç University, School of Medicine , Department of Hematology , Istanbul , Turkey.
authors.forename: Erman
authors.initials: E
authors.lastname: Öztürk
authors.affiliation: c Koç University, School of Medicine , Department of Radiation Oncology , Istanbul , Turkey.|d American Hospital-MD Anderson Radiation Treatment Center , Istanbul , Turkey.|e Radiation Oncology at University of Texas M.D. Anderson Cancer Center , Houston, TX , USA.
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Bölükbaşı
authors.affiliation: f American Hospital, Department of Radiology , Istanbul , Turkey.
authors.forename: Terman
authors.initials: T
authors.lastname: Gümüş
authors.affiliation: g American Hospital, Department of Hematology , Istanbul , Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Örnek
authors.affiliation: h Kozluk State Hospital, Department of Internal Medicine , Batman , Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Özbalak
authors.affiliation: b Koç University, School of Medicine , Department of Hematology , Istanbul , Turkey.|g American Hospital, Department of Hematology , Istanbul , Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Çetiner
authors.affiliation: a Koç University, School of Medicine , Department of Nuclear Medicine and Molecular Imaging , Istanbul , Turkey.|i American Hospital , Department of Nuclear Medicine and Molecular Imag?ng , Istanbul , Turkey.
authors.forename: Onur
authors.initials: O
authors.lastname: Demirkol
authors.affiliation: b Koç University, School of Medicine , Department of Hematology , Istanbul , Turkey.|g American Hospital, Department of Hematology , Istanbul , Turkey.
authors.forename: Burhan
authors.initials: B
authors.lastname: Ferhanoğlu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D001761:Bleomycin / Q000009:adverse effects* / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006689:Hodgkin Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology*; D000072078:Positron Emission Tomography Computed Tomography; D049268:Positron-Emission Tomography / Q000379:methods; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000903:Antibiotics, Antineoplastic; D019788:Fluorodeoxyglucose F18; D001761:Bleomycin
keywords: Bleomycin; Hodgkin lymphoma; PET-CT; bleomycin lung injury; bleomycin-induced pneumonitis; pneumonitis