Assessment of fitness for bleomycin use and management of bleomycin pulmonary toxicity in patients with classical Hodgkin lymphoma: A British Society for Haematology Good Practice Paper

Aisling Barrett; Nimish Shah; Andrew Chadwick; David Burns; Cathy Burton; David J Cutter; George A Follows; Pam McKay; Wendy Osborne; Elizabeth Phillips; Matthew R Wilson; Graham P Collins

doi:10.1111/bjh.19840

Assessment of fitness for bleomycin use and management of bleomycin pulmonary toxicity in patients with classical Hodgkin lymphoma: A British Society for Haematology Good Practice Paper

Br J Haematol. 2024 Nov 6. doi: 10.1111/bjh.19840. Online ahead of print.

Authors

Aisling Barrett^{1

2}, Nimish Shah³, Andrew Chadwick⁴, David Burns⁵, Cathy Burton⁶, David J Cutter⁷, George A Follows⁸, Pam McKay⁹, Wendy Osborne^{10

11}, Elizabeth Phillips¹², Matthew R Wilson⁹, Graham P Collins^{1

2}

Affiliations

¹ Department of Haematology, Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
² Medical Sciences Division, University of Oxford, Oxford, UK.
³ Department of Haematology, Norfolk and Norwich University Foundation Hospital, Norwich, UK.
⁴ Intensive Care Medicine and Anaesthesia, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁵ Department of Haematology, University Hospitals Plymouth NHS Trust, Plymouth, UK.
⁶ Department of Haematology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁷ Department of Oncology, Oxford Cancer and Haematology Centre, University of Oxford, Oxford, UK.
⁸ Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁹ Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK.
¹⁰ Department of Haematology, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK.
¹¹ Newcastle University, Newcastle, UK.
¹² Department of Haematology, The Christie NHS Foundation Trust, Manchester, UK.

PMID: 39506502
DOI: 10.1111/bjh.19840

Abstract

This good practice paper (GPP) is intended to support clinicians in assessing patient fitness for bleomycin and in management of bleomycin pulmonary toxicity (BPT) where it occurs. Bleomycin, originally developed as an antibiotic in the 1960s, has been a cornerstone of therapy for classical Hodgkin lymphoma (CHL) since results of its use in combination with doxorubicin, vincristine and dacarbazine (ABVD) were first published by Bonadonna et al in 1975 1. The same author recognised high rates of respiratory morbidity in these patients 2, and bleomycin-;related pulmonary toxicity (BPT) is now a well-;recognised and feared complication with its use. ABVD and BEACOPP/ BEACOPDac (bleomycin, cyclophosphamide, etoposide, doxorubicin, vincristine and prednisolone, with procarbazine or dacarbazine) are standard first-;line treatments in CHL patients, but considerable variation remains in assessing patient fitness for bleomycin both clinically and with respiratory investigations. A recent survey of British haematologists regularly using bleomycin revealed that 87.5% have no local protocols for assessing patients in an evidence-;based fashion, with wide variations in practice captured in the same survey (personal data). A working group was established and a literature review undertaken with the goal of presenting practical recommendations for clinicians regarding bleomycin use based on available evidence and expert opinion.

Keywords: hodgkins lymphoma; lymphoid malignancies; malignant lymphomas.