Fever bleomycin

Bleomycin -antitumor antibiotic that causes DNA strand breakage -dose-related pneumonitis -mucocutaneous effects (stomatitis, mucositis) -acute pulmonary edema -fever in 50% -hyperpigmentation (can rarely be DLT)... 

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. 

Bleomycin Oxygen free radicals bind to DNA causing single- and double-strand DNA breaks Hodgkin s and non-Hodgkin s lymphoma, germ cell cancer, head and neck cancer Allergic reactions, fever, hypotension Skin toxicity, pulmonary fibrosis, mucositis, alopecia... 

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... 

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. 

Bleomycin Nausea and vomiting fever anaphylaxis and other allergic reactions phlebitis ai in ecuon site Pneumonitis and pulmonary fibrosis rash and hyperpigmenwtion stomatitis alopecia Raynaud s phenomenon cavitating granulomas haemorrhagic cystitis... 

When bleomycin is used as a sclerosing agent in adults, a dose of up to 1 mg/kg is generally instilled into the chest through a thoracostomy tube. Bleomycin 60 mg intrapleu-rally caused a fever over 39°C in two of 21 patients with malignant pleural effusions it settled without treatment and was not associated with local discomfort (15). 

When intravenous tetracycline became no longer available, many centers began to use doxycycline as a sclerosant. In one review (18), chest pain was the most frequent adverse event with doxycycline, occurring in about 40% of the 60 patients in whom it had been used, and fever occurred in about 7%. In a more recent controlled trial in 106 patients treated with either doxycycline or bleomycin, there was chest pain in 20% of the patients treated with doxycycline, and nausea in one patient (19). 

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). 

Toxicity The toxicity profile of bleomycin includes pulmonary dysfunction (pneumonitis, fibrosis), which develops slowly and is dose-limiting. H)q)ersensitivity reactions (chills, fever, anaphylaxis) are common, as are mucocutaneous reactions (alopecia, blister-formation, hyperkeratosis). 

Bleomycin causes DNA strand breaks by producing toxic free radicals. It is often used in combination therapy for lymphomas, head and neck and testicular cancer because it produces little bone marrow toxicity. It does however cause dose-dependent pulmonary fibrosis, oral ulcers, fever and chills. 

Fig. 27.15. A 40-year-old male received chemotherapy including Bleomycin (PEB protocol) for testicular cancer. HRCT was performed because of fever, cough and dyspnoea. HRCT revealed peripheral intralobular septa and ground-glass opacification. Due to the known pulmonary toxicity of the applied Bleomycin, a pulmonary drug toxicity was suspected and verified by open lung biopsy. Symptoms disappeared and findings decreased after application of steroids. Note the similarity to Fig. 27.13...

The pulmonary toxicity of busulfan was first reported in 1961. No clear risk factors for the development of lung toxicity have been consistently identified. The reported incidence of lung toxicity is 6% (4). The onset is typically subacute with fever and dry cough. Bleomycin is histologically characterized by NSIP or UIP. Pulmonary veno-occlusive disease and DIP have also been reported (1). Occasionally, busulfan may lead to alveolar proteinosis secondary to massive deposition of intracellular debris. This form of alveolar proteinosis is poorly responsive to whole lung lavage, and the role of steroids is not clearly estabhshed (9). 

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