Bleomycin Sulfate Toxicity

Pts with a history of germ cell tumors, lymphomas, squamous cell carcinomas, Kaposi sarcomas, and cervical cancers treated with BLM

Incidence of BLT is 10–40%; mortality is 1–2%

Risk of BLT increases with total dose >400 unit, glomerular filtration rate <80 mL/min, or advanced tumor stage at time of diagnosis

History of concurrent thoracic irradiation cisplatin administration

Age greater than 40 y

History of smoking or exposure to high FiO ₂ s

Exposure to high FiO ₂ may increase risk of developing pneumonitis and potentially lethal ARDS in periop setting.

Preexisting lung pathology in combination with low FiO ₂ may result in hypoxia.

Risk of pulm injury is greatest within about 8 mo of administration, but BLM likely confers an elevated lifetime risk of BLT.

Pulm adverse events rarely related to the intrapleural or intralesional administration of BLM.

Periop exposure to high FiO ₂ s (>30%)

Periop hypoxia

Fluid overload, transfusion of red cells, and prolonged operative time

Intrapleural administration of BLM, which has been associated with local pain and hypotension requiring symptomatic treatment