CHESAPEAKE, VA — Bleomycin, the first line standard of care for Hodgkin lymphoma causes pulmonary events in some patients, but physicians have been uncertain how many patients are affected and how long they remain at risk.

Researchers led by Tod A. Morris, MD, of the Naval Medical Center Portsmouth in Chesapeake, VA, provided quantifiable answers in a study released in conjunction with the 2018 American Society of Clinical Oncology Annual Meeting in Chicago this weekend.1

The retrospective cohort study analyzed data from the MHS from Jan. 1, 2005 to Dec. 31, 2013 on 642 adults diagnosed with Hodgkin lymphoma. Patients were followed until death, disenrollment or June 30, 2016. Exclusions included prior malignancies and receipt of less than two chemotherapy agents as first line treatment.

Of the 642 patients with Hodgkin lymphoma identified, 551 received bleomycin. In 85.2% of those patients, bleomycin formed part of their first line therapy, while 4.7% received bleomycin as a component of a second line regimen. New pulmonary events occurred at about the same rate in patients who received bleomycin alone, 29%, and those who received a combination of bleomycin and radiation therapy (30%). Pulmonary events included pulmonary fibrosis, pneumonitis, interstitial lung disease, pneumonia, bronchiolitis obliterans, and acute respiratory distress syndrome.

The researchers found that, while many patients experienced pulmonary events during treatment, bleomycin elevated risk of pulmonary events for up to 36 months. About 10% of all pulmonary events occurred in the first six months after bleomycin treatment, with or without radiation therapy, and 15% happened in the first year.

An additional 7% of all events in the study occurred in year two, then the rate tapered off with another 2.7% in year three, and a further 1.9% in year four, for a total of 29.6% through the entire follow up period.

“A high proportion of HL patients experienced new pulmonary events within 2 years of receiving initial treatment containing bleomycin,” study authors concluded. “While many events occurred during treatment, the majority happened up to 36 months after completion.”

1Morris TA, Feliciano J, Fox K, et al. Pulmonary events in patients with Hodgkin lymphoma after first line chemotherapy in the US Department of Defense healthcare system. J Clin Oncol 36, 2018 (suppl; abstr e22070)