Bleomycin Side Effects

This article looks at bleomycin side effects. Bleomycin is one of the oldest workhorses in the chemotherapeutic stockpile, dating back to its discovery in the mid 1960s and its FDA approval in 1973. It has a proven efficacy profile as an agent against several cancers, but here at the Lymphoma Information Network we're only concerned with the drug's widespread use against lymphomas, chiefly Hodgkin's lymphoma—where we find it in the combination chemotherapy regimens ABVD, BEACOPP, and Stanford V. It is also used, sparingly, against non-Hodgkin's lymphomas such as in the MACOP-B regimen.

When a drug has been around this long, several truths emerge about the drug that may or may not have been known when the drug first was approved for use by government agencies like the FDA. We can therefore discuss the potential bleomycin side effects with a degree of confidence unavailable in newer drugs.

Bleomycin Side Effects

The most commonly reported bleomycin side effects are fever, chills, rash, anorexia, mouth sores, shortness of breath, and sudden chest pains. However, there is a much more insidious side effect lurking behind bleomycin that all potential patients should be made clearly aware of, and that is BPT.

Bleomycin Pulmonary Toxicity (BPT)

Perhaps no other bleomycin side effects are as potentially devastating or fatal as what is known as Bleomycin Pulmonary Toxicity or BPT. This occurs in about 10 percent of patients, and is believed to prove fatal in 1 percent. It can manifest as any of the following:

-- Acute pneumonitis
-- Chronic pulmonary fibrosis
-- Acute respiratory distress syndrome

There are a number of risk factors that can pre-dispose people to developing BPT, and they are:

-- Prior compromised pulmonary function
-- Prior compromised renal function
-- Being age 40 or older
-- Being a smoker
-- Receiving radiation to the chest
-- Being administered chemo drugs such as cisplatin, cyclophosphamide, methotrexate or doxorubicin at the same time.
-- A lifetime cumulative dose in excess of 450 units
-- Oxygen therapy after treatment with bleomycin

The first signs to look for in the development of BPT are:

-- Dry cough
-- Dyspnea (shortness of breath)
-- Basilar rales (cackling sounds from breathing, heard through a stethoscope)
-- Pleurisy (chest pain when taking a deep breath of coughing)
-- Fever

Because BPT is often one of the delayed bleomycin side effects, patients who have received bleomycin are often encouraged to wear health bracelets indicating that they have previously received the drug so that if there is an emergency, responding health care professionals can take caution in giving the patient oxygen. Patients are also discouraged from doing things like SCUBA diving.

Sources

Cancer Drug Manual, BC Cancer Agency.

Bonander, Ross. CancerTreatment.net, Bleomycin.

Perry, Michael C, Editor. Companion Handbook to the Chemotherapy Sourcebook. 1999. Baltimore; Williams & Wilkins.

Sutherland, Judy MD. Bleomycin Associated Lung Toxicity. A Guideline for Oxygen Therapy for Patients who have Received Bleomycin Systemic Therapy.