Bleomycin adverse effects

Adverse effects include hyperthermia, headache, nausea and vomiting. Bleomycin has minimal myelosuppressive activity. It can display sever cutaneous and pulmonary toxicity which can be explained by the low hydrolase activity in these tissues. The pulmonary toxicity may progress to life-threatening pulmonary fibrosis. 

A potentially fatal lung toxicity occurs in 10 to 20% of patients receiving bleomycin. Patients particularly at risk are those who are over 70 years of age and have had radiation therapy to the chest. Rarely, bleomycin also may cause allergic pneumonitis. Bleomycin skin toxicity is manifested by hyperpigmentation, erythematosus rashes, and thickening of the skin over the dorsum of the hands and at dermal pressure points, such as the elbows. Many patients develop a low-grade transient fever within 24 hours of receiving bleomycin. Less common adverse effects include mucositis, alopecia, headache, nausea, and arteritis of the distal extremities. 

Generic Name Bleomycin Trade Name Blenoxane Primary Antineoplastic Indication(s) Carcinoma of head, neck, cervical region, skin, penis, vulva, and testicle Hodgkin disease non-Hodgkin lymphomas Common Adverse Effects Pulmonary toxicity [interstitial pneumonitis] skin disorders [rash, discoloration] mucosal lesions fever Gl distress general weakness and malaise... 

A few chemotherapeutic agents accumulate in endocytic vesicles probably due to their size and/or charge. Bleomycin (BLM, MW 1.400) is a chemotherapeutic drug approved for the treatment of many forms of cancer. The applicability of bleomycin is, however, limited by the adverse effects of the treatment, especially interstitial pneumonia causing irreversible lung fibrosis in 3% of the treated patients... 

Adverse effects Pulmonary toxicity is the most serious adverse effect, progressing from rales, cough, and infiltrate to potentially fatal fibrosis. Mucocutaneous reactions and alopecia are common. Hypertrophic skin changes and hyperpigmentation of the hands are prevalent. There is a high incidence of fever and chills and a low incidence of serious anaphylactoid reactions. Bleomycin is unusual in that myelosuppression is rare. 

Because this is a severe adverse effect it is generally recommended that a total dose of more than 400 mg of bleomycin should be avoided in patients with normal renal function. In those over 70 years of age reduced creatinine clearance makes dosage reduction necessary. 

Of 51 patients with malignant pleural effusions, 14 underwent slurry talc pleurodesis via a chest tube, 14 had talc poudrage during Video-Assisted Thoracoscopic exploration of the pleural cavity for suspected malignant effusion, and 24 underwent chemical pleurodesis with bleomycin via a chest tube (16). The most common adverse effects were chest pain and fever. The duration of adverse effects after talc pleurodesis was longer (2-3 days) than after bleomycin. There was chest pain in 15 of the 28 patients who received talc, with a duration of 18-52 (median 31) hours. There was fever in 22 of those who received talc, with a duration of 5-34 (median 12.5) hours. Complications were more common in those who received talc, such as thoracic empyema n — 1), wound infection n — 2), and respiratory distress n — 5). 

The most serious adverse effect of talc is a possible association between talc pleurodesis and the development of acute respiratory failure (usually in the form of ARDS) over 30 cases have been described (13) after intrapleural talc either as a slurry (8) or insufflated (18,19). The literature on acute respiratory failure after intrapleural talc has been reviewed, with recommendations on whether talc should continue to be used to produce pleurodesis (20). Some believe that intrapleural talc should not be used to produce a pleurodesis, since there are effective alternatives for producing pleurodesis (mechanical abrasion if thoracoscopy is performed, tetracycline derivatives or bleomycin if chest tubes are used). 

Pacific Northwest.) Encyclopedic references comment that the antibiotics doxorubicin, daunorubicin, bleomycin, mitomycin, and dactinomycin are all antineoplastic or anticancer agents, but are mostly too toxie for antibiotic use (and perhaps are too toxic to be used as anticancer agents, a ease again of adverse side effects). 

Importantly, the toxicity of bleomycin is cumulative. Total doses in excess of 450 units are associated with a significantly increased incidence of adverse lung reactions and death. The incidence of bleomycin-induced lung toxicity has been reported between 0% and 46% with a mortality rate of 3% (5,7). As mentioned above, high cumulative dose, extreme of age, uremia, the use of supplemental oxygen, and radiation therapy are well-documented risk factors for bleomycin toxicity. Other chemotherapeutic agents (cyclophosphamide and vincristine) may also have a synergistic effect with bleomycin. Finally, bleomycin may occasionally reactivate a prior radiation-induced pneumonitis, a phenomenon known as radiation-recall. ... 

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