High Resolution Computed Tomography of Bleomycin-Induced Lung Injury in Hodgkin Lymphoma.

Bleomycin is the chemotherapeutic agent most commonly associated with pulmonary toxicity in about 4–20% of treated patients. The diagnosis of bleomycin-induced lung disease is primarily clinical and there is no true gold standart test available. In this study, we aimed to evaluate the role of high resolution computed tomography (HRCT) in monitoring patients for drug toxicity.

We prospectively evaluated the HRCT scans of 18 newly diagnosed hodgkin lymphoma patients baseline, after the fourth and the eight cycle of ABVD (Adriamycin-bleomycin-vinblastine-dacarbazine) chemotherapy. The age ranges of the patients was 17–69 years (mean, 35 years). Serial PFTs and arterial blood gases were obtained in addition to imaging studies during bleomycin therapy. The parenchymal abnormalities on HRCT were grouped into different categories according to the dominant pattern and distribution of disease: diffuse alveolar damage (DAD), nonspecific interstitial pneumonitis (NSIP), bronchiolitis obliterans organizing pneumonia (BOOP), interstitial pneumonitis and fibrosis and hypersensitivity reaction. Pulmonary parenchymal abnormalities were detected on HRCT in 5 of 18 patients (27.8%). Patient details, cumulative doses of bleomycin and patterns of lung injury are presented in table. Arterial O₂ pressure (p<0.01), O₂ saturation (p<0.01) and carbon monoxide diffusing capacity (DLCO) (p<0.01) were decreased after bleomycin therapy compared to baseline values in 18 patients.

Our results indicate that HRCT is useful in the diagnosis of bleomycin-induced lung disease by better characterization of the nature of the abnormality and assessment of extent and distribution of disease.