Pulmonary Medicine, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey,
Pulmonary Medicine, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey.
Acta Haematol. 2019;142(3):171-175. doi: 10.1159/000502374. Epub 2019 Aug 27.
Bleomycin is an antitumor antibiotic used successfully to treat a variety of malignancies, predominantly germ cell tumors and Hodgkin's lymphoma (HL). The major limitation of bleomycin therapy is the potential for life-threatening interstitial pulmonary fibrosis. Early identification of asymptomatic patients who may develop toxicity is important. We aimed to evaluate fluorodeoxyglucose positron-emission tomography (FDG-PET/CT) findings to predict bleomycin toxicity (BT) early after chemotherapy with doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy before clinical symptoms and radiological changes occur.
HL patients who were treated with ABVD were evaluated. SUVmax values of lung parenchyma were analyzed in FDG-PET/CT at diagnosis and after 4 cycles of chemotherapy in all patients. At the end of the chemotherapy cycles, lung parenchymal SUVmax values of patients with BT and without BT were compared statistically.
Twenty (66.7%) male and 10 (33.3%) female patients with HL were included. Five (16.7%) HL patients developed BT. In 3 HL patients, BT was determined after 5 cycles and in 2 patients, BT was seen after 6 cycles. In all 5 of these patients with BT, FDG uptake in PET-CT was increased after 4 cycles of chemotherapy and BT was predicted before clinical and radiological findings by FDG-PET/CT. After 4 cycles of chemotherapy, lung parenchymal SUVmax of patients with BT (3.24 ± 0.76) was significantly higher than in patients without toxicity (1.84 ± 0.52) (p < 0.001). In patients with BT, a significant increase was established in lung parenchymal SUVmax after 4 cycles of chemotherapy when compared to the time of diagnosis (p = 0.043).
BT can be fatal. Early detection of BT is essential in clinical practice. FDG-PET/CT can predict BT before clinical and radiological findings occur.
博莱霉素是一种抗肿瘤抗生素，成功地用于治疗多种恶性肿瘤，主要是生殖细胞肿瘤和霍奇金淋巴瘤（HL）。博莱霉素治疗的主要限制是潜在的致命性间质性肺纤维化。早期识别可能发生毒性的无症状患者很重要。我们旨在评估氟脱氧葡萄糖正电子发射断层扫描（FDG-PET/CT）结果，以预测多柔比星、博莱霉素、长春碱、达卡巴嗪（ABVD）化疗后在出现临床症状和影像学改变之前早期发生博莱霉素毒性（BT）。
评估接受 ABVD 治疗的 HL 患者。所有患者均在诊断时和化疗 4 周期后进行 FDG-PET/CT 分析肺实质的 SUVmax 值。在化疗周期结束时，比较 BT 患者和无 BT 患者的肺实质 SUVmax 值。
20 名（66.7%）男性和 10 名（33.3%）女性 HL 患者入组。5 名（16.7%）HL 患者发生 BT。3 例 HL 患者在 5 个周期后确定 BT，2 例在 6 个周期后确定 BT。在所有这 5 例有 BT 的患者中，在化疗 4 周期后 FDG 在 PET-CT 中的摄取增加，并且在临床和影像学发现之前通过 FDG-PET/CT 预测 BT。在化疗 4 周期后，BT 患者的肺实质 SUVmax（3.24 ± 0.76）明显高于无毒性患者（1.84 ± 0.52）（p <0.001）。与诊断时相比，BT 患者在化疗 4 周期后肺实质 SUVmax 显著增加（p = 0.043）。
BT 可能是致命的。在临床实践中，早期发现 BT 至关重要。FDG-PET/CT 可在出现临床和影像学发现之前预测 BT。
