Bleomycin Pulmonary Toxicity in Patients with Germ Cell Tumors Treated with Bleomycin Containing Regimens: Experience with 4 Cases

Background: Information on Bleomycin pulmonary toxicity (BPT) in Qatar is scarce. The aim of this study was to estimate the prevalence of BPT and to describe its clinical significance and outcome in germ cell tumor (GCT) patients who received bleomycin-containing regimens.Methods: This retrospective cross-sectional study was conducted at the National Center for Cancer Care and Research. It included all patients diagnosed with GCT and treated with a bleomycin-containing regimen between January 2002 and December 2008 Results: We identified fourteen patients with GCT who received bleomycin containing regimen. Four of them (28.5%) had developed BPT, and they were males with mean age of 39.3±8.3 years (range: 25-46 years). The calculated creatinine clearance before treatment was normal in the 4 cases. Evaluation of the chest computed tomography scan before starting bleomycin containing regimens revealed that none of our patients had pre-existing parenchymal lung disease. The mean cumulative bleomycin dose was 187.5± 153.7 U, while the mean time to onset of BPT was 3.5±2.1 months. Once the diagnosis of BPT was established, bleomycin was discontinued in the four patients and short courses of dexamethasone were administered. Two patients (50%) died, while one patient survived with a fibrosis sequel, and the fourth patient recovered without a fibrosis sequel. Conclusion: BPT is one of the life-threatening side effects of this drug that every doctor should be aware of when treating GCT, therefore, a high index of suspicious is needed for early recognition of BPTs.