Bleomycin Induced Pulmonary Fibrosis

Q: 24 year old male is admitted in ICU.  Oncology service made decision to start bleomycin  for his underlying cancer. Which organ insufficiency may increase the risk of bleomycin induced pulmonary fibrosis?

A) previous lung insufficiency
B) renal insufficiency
C) liver insufficiency
D) cardiomyopathy
E) pancreatic insufficiency


Answer:  B

Total cumulative dose is mainly responsible for its lung toxicity and as  most of the bleomycin  is eliminated via kidney, renal insufficiency increases the risk of pulmonary fibrosis. Another risk factor is  rapid  infusion of the drug.



References:

1. Kawai K, Hinotsu S, Tomobe M, Akaza H. Serum creatinine level during chemotherapy for testicular cancer as a possible predictor of bleomycin-induced pulmonary toxicity. Jpn J Clin Oncol 1998; 28:546. 

2. Sleijfer S, van der Mark TW, Schraffordt Koops H, Mulder NH. Enhanced effects of bleomycin on pulmonary function disturbances in patients with decreased renal function due to cisplatin. Eur J Cancer 1996; 32A:550.

3. Carlson RW, Sikic BI. Continuous infusion or bolus injection in cancer chemotherapy. Ann Intern Med 1983; 99:823. 

4. Cooper KR, Hong WK. Prospective study of the pulmonary toxicity of continuously infused bleomycin. Cancer Treat Rep 1981; 65:419.