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Vandtved JH, Øvlisen AK, Baech J, Weinrich UM, Severinsen MT, Maksten EF, Jakobsen LH, Glimelius I, Kamper P, Hutchings M, Specht L, Dahl-Sørensen R, Christensen JH, El-Galaly TC. Pulmonary diseases in patients with classical Hodgkin lymphoma relative to a matched background population: A Danish national cohort study. Br J Haematol 2024; 205:542-551. [PMID: 38685596 DOI: 10.1111/bjh.19475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 05/02/2024]
Abstract
Late toxicities can impact survivorship in patients with classical Hodgkin lymphoma (cHL) with pulmonary toxicity after bleomycin-containing chemotherapy being a concern. The incidence of pulmonary diseases was examined in this Danish population-based study. A total of 1474 adult patients with cHL treated with ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) or BEACOPP (bleomycin, vincristine, etoposide, doxorubicin, cyclophosphamide, procarbazine and prednisone) between 2000 and 2018 were included along with 7370 age- and sex-matched comparators from the background population. Median follow-up was 8.6 years for the patients. Patients with cHL had increased risk of incident pulmonary diseases (HR 2.91 [95% CI 2.30-3.68]), with a 10-year cumulative risk of 7.4% versus 2.9% for comparators. Excess risks were observed for interstitial lung diseases (HR 15.84 [95% CI 9.35-26.84]) and chronic obstructive pulmonary disease (HR 1.99 [95% CI 1.43-2.76]), with a 10-year cumulative risk of 4.1% and 3.5% respectively for patients. No excess risk was observed for asthma (HR 0.82 [95% CI 0.43-1.56]). Risk factors for interstitial lung diseases were age ≥60 years, the presence of B-symptoms and low albumin. These findings document a significant burden of pulmonary diseases among patients with cHL and emphasize the importance of diagnostic work-up of pulmonary symptoms.
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Affiliation(s)
- Julie Haugaard Vandtved
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Andreas Kiesbye Øvlisen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Joachim Baech
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Møller Weinrich
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Marianne Tang Severinsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Eva Futtrup Maksten
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Lasse Hjort Jakobsen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Peter Kamper
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lena Specht
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Tarec C El-Galaly
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institute, Stockholm, Sweden
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Soldi LR, Rabelo DH, da Silva PHR, Silva VLC, Silva MJB. The Impact of Bleomycin Deficit on Survival in Hodgkin's Lymphoma Patients: A Retrospective Study. Cancer Treat Res Commun 2024; 38:100790. [PMID: 38241969 DOI: 10.1016/j.ctarc.2024.100790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/03/2024] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Abstract
PURPOSE Hodgkin's lymphoma is currently treated with a chemotherapy protocol consisting of doxorubicin, bleomycin, vinblastine, and dacarbazine. Due to Brazil facing a bleomycin shortage in 2017, and this drug's high toxicity, this retrospective study evaluates the effect that the absence of bleomycin had on treatment response and overall survival of Hodgkin's lymphoma patients. METHODS The medical records of 126 HL patients treated between 2007 and 2021 were reviewed and their data collected, followed by grouping into ABVD and AVD groups according to bleomycin use. Data concerning the patient's characteristics, cancer type, and treatment plan were analyzed with proportion tests, Kaplan-Meier curves. univariate Cox regression, and χ2 tests. RESULTS No discernible differences were found in this study between the overall survival and recurrence rate of patients treated with bleomycin compared to those without. Additionally, there was an increased risk of death in each subsequent cycle of chemotherapy of the complete ABVD protocol, demonstrating a risk of toxicity. Among the variables analyzed, hypertension and the presence of B symptoms were also associated with an increased risk of death, while the use of radiotherapy significantly improved survival. CONCLUSION The results of this study suggest that bleomycin did not impact the outcome of Hodgkin's lymphoma treatment. Moreover, the increased risk of death associated with its toxicity during each cycle of treatment raises concerns about its role as an essential component of the gold standard for Hodgkin's lymphoma treatment. Therefore, further research and consideration are needed to reassess the use of bleomycin in Hodgkin's lymphoma treatment protocols.
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Affiliation(s)
- Luiz Ricardo Soldi
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil; Tumor Biomarkers and Osteoimmunology Laboratory, Av. Pará - 1720 - Block 6T, Room 07 - District Umuarama, Uberlândia, MG, Brazil; Student of the Graduate Program in Applied Immunology and Parasitology, Federal University of Uberlândia, Brazil..
| | - Diogo Henrique Rabelo
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil; Tumor Biomarkers and Osteoimmunology Laboratory, Av. Pará - 1720 - Block 6T, Room 07 - District Umuarama, Uberlândia, MG, Brazil; Student of the Graduate Program in Applied Immunology and Parasitology, Federal University of Uberlândia, Brazil..
| | - Paulo Henrique Rosa da Silva
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil; Tumor Biomarkers and Osteoimmunology Laboratory, Av. Pará - 1720 - Block 6T, Room 07 - District Umuarama, Uberlândia, MG, Brazil; Student of the Graduate Program in Applied Immunology and Parasitology, Federal University of Uberlândia, Brazil..
| | - Victor Luigi Costa Silva
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil; Tumor Biomarkers and Osteoimmunology Laboratory, Av. Pará - 1720 - Block 6T, Room 07 - District Umuarama, Uberlândia, MG, Brazil.
| | - Marcelo José Barbosa Silva
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil; Tumor Biomarkers and Osteoimmunology Laboratory, Av. Pará - 1720 - Block 6T, Room 07 - District Umuarama, Uberlândia, MG, Brazil.
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Yılmaz U, Zulfaliyeva G, Güzelli AN, Özmen D, Elverdi T, Salihoğlu A, Eskazan AE, Öngören Ş, Başlar Z, Ar MC. Does discontinuing bleomycin due to toxicity increase the risk of lymphoma progression? Real-life data from a homogeneous population of advanced stage Hodgkin lymphoma. J Chemother 2023:1-8. [PMID: 37974409 DOI: 10.1080/1120009x.2023.2281089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
Hodgkin Lymphoma (HL) is often curable with ABVD therapy and improving outcomes is a main goal of ongoing research. Bleomycin-associated pneumonitis (BAPT) is a potentially life-threatening complication that necessitates bleomycin discontinuation. We conducted this study on a homogenous cohort of advanced stage HL treated only with ABVD for frontline therapy to assess if bleomycin discontinuation increases the risk of lymphoma progression. After the exclusion of patients who received radiotherapy or other drugs, 106 and 28 patients in the six-cycle ABVD and BAPT groups respectively had similar survival curves for progression and death with a 49-month median follow-up. PFS rates were also very similar at two and four years from diagnosis with 2-year PFS rates of 83.9% and 82.1% (RR = 1.1 95%CI = 0.45-2.2). Outcome comparisons were also similar between the two groups when stratified according to early response assessment with PET/CT. Patients who discontinued bleomycin due to toxicity did not experience an increased risk of progression compared to patients who completed six ABVD cycles.
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Affiliation(s)
- Umut Yılmaz
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Güldane Zulfaliyeva
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Adnan Nuri Güzelli
- Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Deniz Özmen
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Tuğrul Elverdi
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ayşe Salihoğlu
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Şeniz Öngören
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Zafer Başlar
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Mahdi Seyedzadeh Sani S, Sahranavard M, Jannati Yazdanabad M, Seddigh Shamsi M, Elyasi S, Hooshang Mohammadpour A, Sathyapalan T, Arasteh O, Ghavami V, Sahebkar A. The effect of concomitant use of Colony-Stimulating factors on bleomycin pulmonary toxicity - A systematic review and meta-analysis. Int Immunopharmacol 2022; 112:109227. [PMID: 36099787 DOI: 10.1016/j.intimp.2022.109227] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/06/2022] [Accepted: 08/31/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Changes in the incidence of bleomycin pulmonary toxicity (BPT) as a result of adding colony-stimulating factors (CSF) to bleomycin regimens has been investigated in numerous studies. We performed a systematic review and meta-analysis to assess the outcomes of these studies. METHODS A systematic search was performed using Pubmed, Scopus, Web of Science, and Embase on April 2021. Studies evaluating the incidence of BPT in patients receiving bleomycin with and without CSF were included. In addition, meta-analysis was performed by pooling odds ratios using R. RESULTS Out of 340 obtained records, our qualitative and quantitative analysis included 3234 and 1956 patients from 22 and 14 studies, respectively. The quantitative synthesis showed that addition of CSF significantly increased the risk of BPT incidence (OR = 1.82, 95 % CI: 1.37-2.40, p < 0.0001; I2 = 10.7 %). Subgroup analysis did not show any association between continent, bleomycin dose, cancer type, type of study, and pulmonary function test with BPT incidence. CONCLUSION This systematic review and meta-analysis showed that co-administration of CSF with bleomycin increases the incidence of BPT. The physicians need to consider this finding while deciding the best strategy for this cohort of patients.
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Affiliation(s)
| | - Mehrdad Sahranavard
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Science, Mashhad, Iran
| | - Mahdi Jannati Yazdanabad
- Department of Biostatistics and Epidemiology, School of Health, Mashhad University of Medical Science, Mashhad, Iran
| | - Mohsen Seddigh Shamsi
- Department of Hematology Oncology, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Sepideh Elyasi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Science, Mashhad, Iran
| | - Amir Hooshang Mohammadpour
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Science, Mashhad, Iran
| | - Thozhukat Sathyapalan
- Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, UK
| | - Omid Arasteh
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Science, Mashhad, Iran.
| | - Vahid Ghavami
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Science, Mashhad, Iran.
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; School of Medicine, The University of Western Australia, Perth, Australia; School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Ognerubov NA, Antipova TS, Ognerubov SA. Pulmonary toxicity induced by the use of bleomycin in patients with germ cell testicular tumors. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.3.201529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction. Pulmonary toxicity induced by bleomycin is a dangerous complication of polychemotherapy in patients with germ cell tumors. It occurs with a frequency of up to 46%, and in 14% of cases it is fatal.
Aim. To present cases of pulmonary toxicity during polychemotherapy with the inclusion of bleomycin for testicular germ cell tumors.
Materials and Methods. Two patients aged 43 and 33 years old with testicular germ cell tumors were under observation after orchifuniculectomy who underwent chemotherapy according to the BER scheme (bleomycin + etoposide + cisplatin) in the steady-state mode in 4 and 6 cycles respectively. Positron emission tomography combined with computer tomography (PET/CT) with 18F-fluorodeoxyglucose was performed when clinical symptoms appeared at the end of treatment.
Results. Histologically, the tumor in a 33-year-old patient was a mixed tumor seminoma, embryonal cancer with teratoid cancer elements. Abdominal spiral computed tomography revealed metastases to retroperitoneal lymph nodes. In a 43-year-old patient, the tumor had the structure of fetal cancer with multiple metastases to the lungs, mediastinal lymph nodes and retroperitoneal lymph nodes. Six and four cycles of polychemotherapy according to the BER regimen were administered, respectively. The cumulative dose of bleomycin was 540 and 360 mg in 18 and 12 injections. Treatment was accompanied by the development of febrile neutropenia with G-CSF correction. These risk factors should be considered the most significant. The appearance of respiratory symptoms during treatment should be regarded as a manifestation of pulmonary toxicity. PET/CT is the method of choice for diagnosis. The clinical picture in the observed patients, as well as changes on PET/CT, were detected 2 weeks after chemotherapy was completed.
Conclusion. Pulmonary toxicity induced by the use of bleomycin in patients with germ cell testicular tumors is a very dangerous complication, sometimes with a lethal outcome. Therefore, its early diagnosis taking into account risk factors is of great importance in clinical practice. Among medical imaging methods, a special role is played by PET/CT, which allows predicting toxicity before the clinical and radiological debut.
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[Efficacy and safety of Camrelizumab and AVD in the first-line treatment of classic Hodgkin's lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:431-434. [PMID: 35680603 PMCID: PMC9250959 DOI: 10.3760/cma.j.issn.0253-2727.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Tanaka Y, Asai S, Hashimoto A, Shinzato I. Hepatic Hodgkin Lymphoma Presenting as Solitary Hepatic Mass Following Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorder in a Patient With Rheumatoid Arthritis. J Med Cases 2021; 12:79-83. [PMID: 34434435 PMCID: PMC8383609 DOI: 10.14740/jmc3636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 11/23/2022] Open
Abstract
Lymphoproliferative disorders (LPDs) occur frequently in patients with rheumatoid arthritis (RA) under methotrexate treatment. Some LPDs spontaneously regressed after methotrexate discontinuation, but classic Hodgkin lymphoma (CHL)-type LPDs frequently relapse, and chemotherapy is usually required for the treatment. CHL usually spreads in contiguous lymph nodes and then infiltrates in organs at an advanced stage. Thus, hepatic Hodgkin lymphoma (HHL) without lymphadenopathy is extremely rare at diagnosis. We present a case of methotrexate-associated LPDs associated with systemic lymphadenopathy and hepatosplenic mass in a 71-year-old woman with RA under methotrexate treatment over 10 years. Although spontaneous remission occurred after methotrexate discontinuation, she developed HHL presenting as a solitary hepatic mass without lymphadenopathy 3 years after spontaneous regression. She received brentuximab vedotin (BV) combination chemotherapy without bleomycin to avoid pulmonary toxicity. Complete metabolic response was achieved after four courses of BV combination chemotherapy, and the activity of RA was kept to be in remission. Our case suggested that the recurrence lesions of LPDs may present at unexpected site, which is not coincide with the primary site, and BV combination chemotherapy is a promising regimen for limited-stage CHL-type LPDs in patients with RA owing to its anti-lymphoma effect on CHL-type LPDs and a possible targeted therapy for RA.
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Affiliation(s)
- Yasuhiro Tanaka
- Department of Hematology and Clinical Immunology, Kobe City Nishi-Kobe Medical Center, 5-7-1, Koji-dai, Nishi-ku, Kobe City, 651-2273 Hyogo, Japan.,Division of Hematology, Japanese Red Cross Society Wakayama Medical Center, 4-20, Komatsubaradori, Wakayama City, 640-8558 Wakayama, Japan
| | - Satsuki Asai
- Department of Pathology, Kobe City Nishi-Kobe Medical Center, 5-7-1, Koji-dai, Nishi-ku, Kobe City, 651-2273 Hyogo, Japan
| | - Akiko Hashimoto
- Department of Hematology and Clinical Immunology, Kobe City Nishi-Kobe Medical Center, 5-7-1, Koji-dai, Nishi-ku, Kobe City, 651-2273 Hyogo, Japan
| | - Isaku Shinzato
- Department of Hematology and Clinical Immunology, Kobe City Nishi-Kobe Medical Center, 5-7-1, Koji-dai, Nishi-ku, Kobe City, 651-2273 Hyogo, Japan
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The Role of Hypertension and Renin-angiotensin-aldosterone System Inhibitors in Bleomycin-induced Lung Injury. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:e321-e327. [PMID: 33127326 DOI: 10.1016/j.clml.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/03/2020] [Accepted: 10/04/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The risk factors for bleomycin-induced lung injury (BLI), a fatal complication of cancer chemotherapy, are not well-established. The renin-angiotensin-aldosterone system (RAAS) has recently been suggested to play a role in the development of lung injury. This study clarified the impact of hypertension (HTN) and the administration of RAAS inhibitors on BLI occurrence in patients treated with bleomycin-containing regimens. PATIENTS AND METHODS We retrospectively analyzed the data of 190 patients treated with a bleomycin-containing regimen for Hodgkin lymphoma or germ cell tumors at our institutions from 2004 to 2018. RESULTS Overall, 190 patients received bleomycin, and symptomatic BLI occurred in 21 (11.1%) cases. In the multivariate analysis, age ≥ 65 years (odd ratio, 10.90; 95% confidence interval, 3.72-32.20; P < .001) and history of HTN (odds ratio, 3.32; 95% confidence interval, 1.07-10.30; P = .04) were found to be significant risk factors for BLI onset. BLI occurred in 3.6% (n = 5) of patients with no risk, 11.8% (n = 2) of those whose only risk factor was HTN, 31.6% (n = 6) of those whose only risk factor was age ≥ 65 years, and 57.1% (n = 8) of those with both risk factors (P < .001). BLI-induced mortality rates in each group were 0.0% (n = 0), 5.9% (n = 1), 10.5% (n = 2), and 42.9% (n = 6) (P < .001), respectively. Among 31 patients with HTN, BLI incidence was 12.5% in patients who were administered RAAS inhibitors and 53.3% in those who were not (P = .02). CONCLUSION Older age and history of HTN were independent risk factors for the development of BLI, and the administration of RAAS inhibitors might reduce the onset of BLI.
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Dores GM, Curtis RE, Dalal NH, Linet MS, Morton LM. Cause-Specific Mortality Following Initial Chemotherapy in a Population-Based Cohort of Patients With Classical Hodgkin Lymphoma, 2000-2016. J Clin Oncol 2020; 38:4149-4162. [PMID: 32946352 DOI: 10.1200/jco.20.00264] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Mortality for patients with classical Hodgkin lymphoma (cHL) treated during an era characterized in the United States by widespread use of doxorubicin, bleomycin, vinblastine, and dacarbazine and diminishing use of radiotherapy is not well understood. PATIENTS AND METHODS We identified 20,007 individuals diagnosed with stage I/II (early) or III/IV (advanced) cHL between age 20 and 74 years treated with initial chemotherapy in US population-based cancer registries during 2000-2015 (follow-up through 2016). We used standardized mortality ratios (SMRs) to compare cause-specific relative mortality risk following cHL to that expected in the general population and estimated excess absolute risks (EARs; per 10,000 patient-years) to quantify disease-specific death burden. RESULTS We identified 3,380 deaths in the cHL cohort, including 1,321 (39%) not attributed to lymphoma. Overall, noncancer SMRs were increased 2.4-fold (95% CI, 2.2 to 2.6; observed, 559; EAR, 61.6) and 1.6-fold (95% CI, 1.4 to 1.7; observed, 473; EAR, 18.2) for advanced- and early-stage cHL, respectively, compared with the general US population. SMRs and EARs differed substantially by cause of death and cHL stage. Among the highest EARs for noncancer causes of death were those for heart disease (EAR, 15.1; SMR, 2.1), infections (EAR, 10.6; SMR, 3.9), interstitial lung disease (ILD; EAR, 9.7; SMR, 22.1), and adverse events (AEs) related to medications/drugs (EAR, 7.4; SMR, 5.0) after advanced-stage cHL and heart disease (EAR, 6.6; SMR, 1.7), ILD (EAR, 3.7; SMR, 13.1), and infections (EAR, 3.1; SMR, 2.2) after early-stage cHL. Strikingly elevated SMRs for ILD, infections, and AEs were observed < 1 year after cHL. Individuals age 60-74 years with advanced-stage cHL experienced a disproportionate excess of deaths as a result of heart disease, ILD, infections, AEs, and solid tumors. CONCLUSION Despite evolving cHL treatment approaches, patients continue to face increased nonlymphoma mortality risks from multiple, potentially preventable causes. Surveillance, early interventions, and cHL treatment refinements may favorably affect patient longevity, particularly among high-risk subgroups.
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Affiliation(s)
- Graça M Dores
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD.,US Food and Drug Administration, Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, Silver Spring, MD
| | - Rochelle E Curtis
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Nicole H Dalal
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD.,Duke University School of Medicine, Durham, NC
| | - Martha S Linet
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Lindsay M Morton
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
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10
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Thakkar DN, Prapath I, Adithan S, Ramasamy K, Selvarajan S, Dubashi B. Variants in XPC, Noxa and TLR4 genes are not associated with bleomycin-induced lung injury in Hodgkin lymphoma patients. Per Med 2020; 17:203-212. [PMID: 32320335 DOI: 10.2217/pme-2019-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: Pulmonary toxicity is a well-known adverse reaction of bleomycin. In this study, we investigated the influence of XPC, PMAIP1/Noxa and TLR4 genetic variants on the development of bleomycin-induced lung injury (BILI) in south Indian patients with Hodgkin lymphoma. Materials & methods: Hodgkin lymphoma patients receiving adriamycin, bleomycin, vinblastine and dacarbazine regimen were recruited for the study and BILI was diagnosed based on symptoms and/or radiological signs. DNA samples were genotyped using real-time PCR. Results: A total of 78 patients were recruited in the study and BILI was observed in 17 (21.8%) patients. Polymorphisms in XPC, PMAIP1/Noxa and TLR4 genes were not associated with the development of BILI. Conclusion: The selected genetic polymorphisms do not predict the risk of BILI in south Indian population.
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Affiliation(s)
- Dimpal N Thakkar
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Gorimedu, Puducherry 605006, India
| | - Indumathi Prapath
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Gorimedu, Puducherry 605006, India
| | - Subathra Adithan
- Department of Radio Diagnosis, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Gorimedu, Puducherry 605006, India
| | - Kesavan Ramasamy
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Gorimedu, Puducherry 605006, India
| | - Sandhiya Selvarajan
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Gorimedu, Puducherry 605006, India
| | - Biswajit Dubashi
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Gorimedu, Puducherry 605006, India
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Ichikawa S, Fukuhara N, Saito K, Onodera K, Shirai T, Onishi Y, Yokoyama H, Fujii H, Ichinohasama R, Harigae H. Successful treatment of methotrexate-associated classical Hodgkin lymphoma with brentuximab vedotin-combined chemotherapy: a case series. Int J Hematol 2020; 111:667-672. [PMID: 31955346 DOI: 10.1007/s12185-020-02822-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/28/2019] [Accepted: 01/07/2020] [Indexed: 12/01/2022]
Abstract
Methotrexate (MTX)-associated classical Hodgkin lymphoma (CHL) is unlikely to regress following discontinuation of MTX, and its treatment usually requires chemotherapy. Standard chemotherapy for CHL is the ABVD regimen, which contains pneumotoxic bleomycin. This can be problematic in MTX-CHL patients suffering from an autoimmune disease (AID), such as rheumatoid arthritis (RA), as they frequently have pulmonary complications. However, brentuximab vedotin (BV)-containing chemotherapy without bleomycin (A + AVD regimen) was recently reported to show favorable efficacy for CHL, and could therefore be beneficial in MTX-CHL. We treated three cases of MTX-CHL using the A + AVD regimen. All were female and had received MTX for more than 15 years. Underlying AIDs in these patients were RA in two patients, and overlap syndrome with systemic lupus erythematosus and dermatomyositis in one patient. The A + AVD regimen resulted in a complete response in all patients. Peripheral neuropathy developed in two patients, necessitating reduction of the BV dose. All three patients experienced hematological toxicity necessitating dose reduction; however, no severe adverse effects, including infection or pulmonary complication, were documented. RA was well-controlled without additional immunosuppressants. The A + AVD regimen is a promising chemotherapy for MTX-CHL with favorable efficacy and tolerable toxicity profiles.
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Affiliation(s)
- Satoshi Ichikawa
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan.
| | - Noriko Fukuhara
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan
| | - Kei Saito
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan
| | - Koichi Onodera
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan
| | - Tsuyoshi Shirai
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan
| | - Yasushi Onishi
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan
| | - Hisayuki Yokoyama
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan
| | - Hiroshi Fujii
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan
| | - Ryo Ichinohasama
- Department of Hematopathology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan
| | - Hideo Harigae
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan
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Taparra K, Liu H, Polley MY, Ristow K, Habermann TM, Ansell SM. Bleomycin use in the treatment of Hodgkin lymphoma (HL): toxicity and outcomes in the modern era. Leuk Lymphoma 2019; 61:298-308. [PMID: 31517559 DOI: 10.1080/10428194.2019.1663419] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
One-in-five Hodgkin Lymphoma (HL) patients treated with bleomycin develop bleomycin pulmonary toxicity (BPT). Given bleomycin-omission data with negative interim-PET, we assessed changes in BPT statistics. We retrospectively evaluated 126 ABVD-treated HL patients for overall survival (OS), progression-free survival (PFS), BPT factors, and management. Forty-seven patients developed BPT with 17% BPT-mortality. In univariable analysis, OS was negatively impacted by BPT (HR = 3.6, 95%CI = 1.2-10.6), but not bleomycin-omission (HR = 1.3, 95%CI = 0.5-3.7). In multivariable analysis, BPT was not associated with OS (HR = 3.0, 95%CI = 0.9-9.9). BPT patients were older (46 y vs 33 years) and received less bleomycin (107 vs 215 units) compared to non-BPT patients. BPT was managed primarily with bleomycin-omission. "Recent Era" patients had lower BPT rates (28% vs 48%), mortality (10% vs 21%), and bleomycin doses (7 vs 12 doses), yet higher bleomycin-omission in the absence of the BPT (59% vs 8%) compared to "Early Era". Our data suggest BPT continually impacts OS in ABVD-treated HL patients, however management is changing.
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Affiliation(s)
- Kekoa Taparra
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Heshan Liu
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mei-Yin Polley
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Kay Ristow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Ozyigit LP, Aktas EC, Senbas ZA, Ozturk AB, Ozturk E, Ergonul MO, Tabak L, Ferhanoglu B, Cetiner M, Deniz G. The role of atopy in the pathogenesis of bleomycin pulmonary toxicity. Respir Med 2019; 155:1-5. [PMID: 31255902 DOI: 10.1016/j.rmed.2019.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/26/2019] [Accepted: 06/21/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Bleomycin pulmonary toxicity (BPT) is a potentially life-threatening consequence of bleomycin usage in patients. An overproduction of epithelium-derived cytokines, habitually linked to allergic inflammation, has been recently revealed in experimental models of BPT. METHODS We assessed retrospectively our cohort of patients with Hodgkin Lymphoma treated with bleomycin between 2014 and 2016 for their demographic, clinical features, including BPT development, atopy status and risk factors for BPT. Then they were invited for allergy testing and blood sample collection. The samples were stimulated with different stimuli (Bleomycin, IL-33, TSLP) for 24 h on cell culture. The culture supernatants were analysed for TGF-β, Galectin3, Arginin, Amphiregulin, Eotaxin, IFNγ, TNFα, IL1β, 4, 5, 6, 10, 13, 17, MIP-1α, and bleomycin hydrolase (BLH) levels. RESULTS The cohort consisted of 51 patients showed that atopy was the only significant risk factor for BPT occurrence (OR: 7.2, p = 0.007). Fourteen subjects were included for blood analysis. The analysis of supernatants at the unstimulated condition revealed that BLH and Amphiregulin were significantly lower in patients who had BPT than controls. The BLH cut-off that best identified a history of BPT was 175.31 (Sensitivity: 62.5%, specificity: 100%). Following the stimulation, BLH reduced compared to the unstimulated condition and the difference between groups remained significant (p < 0.05). CONCLUSION Our study is the first to report that low levels of bleomycin hydrolase in allergic individuals may be predisposing to a possible pathway of fibrosis.
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Affiliation(s)
- Leyla Pur Ozyigit
- Koç University, School of Medicine, Department of Allergy and Immunology, Istanbul, Turkey.
| | - Esin Cetin Aktas
- Istanbul University, Aziz Sancar Institute of Experimental Medicine, Department of Immunology, Istanbul, Turkey
| | - Zarif Asucan Senbas
- Koç University, School of Medicine, Department of Allergy and Immunology, Istanbul, Turkey
| | - Ayse Bilge Ozturk
- Koç University Hospital, Department of Allergy and Immunology, Istanbul, Turkey
| | - Erman Ozturk
- Koç University Hospital, Department of Haematology, Istanbul, Turkey
| | - Mehmet Onder Ergonul
- Koç University, School of Medicine, Department of Infectious Diseases, Istanbul, Turkey
| | - Levent Tabak
- Koç University, School of Medicine, Department of Respiratory Medicine, Istanbul, Turkey
| | - Burhan Ferhanoglu
- Koç University, School of Medicine, Department of Haematology, Istanbul, Turkey
| | - Mustafa Cetiner
- Koç University, School of Medicine, Department of Haematology, Istanbul, Turkey
| | - Gunnur Deniz
- Istanbul University, Aziz Sancar Institute of Experimental Medicine, Department of Immunology, Istanbul, Turkey
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Merkle S, Tavernier S. Cannabis Use and Bleomycin: An Overview and Case Study of Pulmonary Toxicity. Clin J Oncol Nurs 2018; 22:438-443. [DOI: 10.1188/18.cjon.438-443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Maruyama Y, Sadahira T, Mitsui Y, Araki M, Wada K, Tanimoto R, Kobayashi Y, Watanabe M, Watanabe T, Nasu Y. Prognostic impact of bleomycin pulmonary toxicity on the outcomes of patients with germ cell tumors. Med Oncol 2018; 35:80. [DOI: 10.1007/s12032-018-1140-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/18/2018] [Indexed: 01/29/2023]
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