A Foe For Lung Is A Friend For Heart: Intrapericardial Bleomycin For Malignant Pericardial Effusion – A Case Series

Malignant pericardial effusion is a potentially fatal problem among patients with advanced malignancies known to cause cardiac tamponade and hemodynamic instability. Pericardiocentesis and pericardial drainage are the standard initial approaches to management; however, they only offer temporary relief in most cases, due to a high rate of recurrence. The use of sclerotherapy via intrapericardial instillation of a sclerosing agent may offer a reasonable alternative. We present a case series of six patients with malignant pericardial effusion in which intrapericardial bleomycin was used to treat the effusion after pericardiocentesis was performed. Each patient received 20 mg bleomycin in 30 mL normal saline instilled into the pericardial space for two hours following image-guided pericardiocentesis, on three consecutive days. Symptoms, drainage amount, and effusion recurrence were used to measure clinical outcomes. Four of the six patients experienced significant symptomatic improvement with resolution of dyspnea and chest discomfort, decreasing subsequent amounts of pericardial drainage, and no recurrence as evaluated at their follow-up appointments. Two patients were not considered adequate treatment responders by the investigators, and experienced ongoing effusion and return of symptoms after therapy completion. There were no meaningful systemic toxicities or procedure complications. In summary, this case series indicates that intrapericardial bleomycin may be a safe and effective treatment option for malignant pericardial effusion, but some patients may not respond, demonstrating the need for tailored treatment decisions for effusions and the need for larger studies to assess reproducibility