LOUIS — Until recently, for patients with Hodgkin Lymphoma, the relationship between increasing age and bleomycin pulmonary toxicity (BPT) remained unclear.

That lack of information led to a VA study, published in the Journal of Geriatric Oncology, which explored associations between age and BPT in a real-world cohort of mostly older patients with the cancer.1

The study led by the St Louis VHA Medical Center Research Service retrospectively evaluated a nationwide patient cohort of veterans diagnosed with Hodgkin Lymphoma in VAMCs between Oct. 1, 2002 and December 31, 2013, with follow up through April 15, 2016.

Defined as the primary outcome was the development of BPT, including ambient air oxygen saturations of less than 92% with pulmonary infiltrates on chest radiograph and no other etiologies  or clinician documentation of BPT.

Of the 847 patients who received chemotherapy overall, 739 of these patients received bleomycin, according to the report, which add that 66 patients (9.3%) developed BPT. Researchers calculated the incidence of BPT per age category as 0.03 (9/262), 0.07 (13/188), 0.13 (23/171), and 0.24 (21/88) for age categories 49 or younger, 50-59, 60-69 and 70 or older, respectively.

“Odds of BPT steadily increased with advancing age (compared to patients age ≤ 49 years) with odds ratios of 1.65 (95% CI 0.68-4.03), 3.24 (1.43-7.34), 6.01(2.52-7.34) for age categories 50-59, 60-69 and ≥ 70 years, respectively,” according to the study team. “There was no association between bleomycin and risk of death up-to five-years [HR: 0.87; 95% CI (0.61-1.23)].”

Researchers suggested their study demonstrated “a direct relationship” between age older than 60 and higher odds of developing clinically significant BPT.

A study published last fall in Leukemia & Lymphoma asserted that one-in-five Hodgkin Lymphoma patients treated with bleomycin develop bleomycin pulmonary toxicity.2

“Given bleomycin-omission data with negative interim-PET, we assessed changes in BPT statistics,” wrote Mayo Clinic researchers who retrospectively evaluated 126 ABVD-treated HL patients (a chemotherapy combination therapy including bleomycin) for overall survival, progression-free survival, BPT factors, and management outside of federal medicine.

In their study, 47 patients developed BPT with 17% BPT-mortality. The study determined that 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).

Researchers also noted that BPT patients were older (46 vs. 33 median age) and received less bleomycin (107 vs. 215 units) compared to non-BPT patients. BPT was managed primarily with bleomycin-omission.

The authors also pointed out that “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,” the study concluded.

  1. Thomas TS, Luo S, Reagan PM, Keller JW, Sanfilippo KM, Carson KR. Advancing age and the risk of bleomycin pulmonary toxicity in a largely older cohort of patients with newly diagnosed Hodgkin Lymphoma. J Geriatr Oncol. 2020;11(1):69–74. doi:10.1016/j.jgo.2019.09.009
  2. 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 [published online ahead of print, 2019 Sep 13]. Leuk Lymphoma. 2019;1–11. doi:10.1080/10428194.2019.1663419