Bleomycin Pulmonary Toxicity in Adult Saudi Patients with Hodgkin’s Lymphoma

Background: Bleomycin pulmonary toxicity (BPT) has been well described in Hodgkin's lymphoma (HL) patients treated with bleomycin-containing chemotherapy regimens. As the effects of genetic susceptibility or race on the development of BPT are largely unknown, we intended to examine BPT incidence, risk factors, and its effects on survival in a series of newly diagnosed Saudi Arabian adult HL patients receiving first-line bleomycin-containing chemotherapy.

Methods: We carried out a retrospective review of the relevant records of 164 consecutive eligible adult HL patients treated at two centers.

Results: BPT was observed in 24 of 164 patients (15%) at a median duration of 4.3 months (range, 1 to 58 months). Older age and history of concomitant lung disease were significantly associated with approximately three- (odds ratio [OR] = 3.38; 95% confidence interval [CI], 1.25-9.13; P = 0.02) and seven-fold (OR = 7.19; 95% CI, 2.64-19.54; P <0.0001) increase in BPT risk, respectively. While more patients in non-BPT group achieved CR as compared with BPT patients (93% vs. 79%; P = 0.048), the actuarial 5-year progression-free (82% vs. 63%; P = 0.29) and overall survival (OS) (94% vs. 76%; P = 0.059) for BPT and non-BPT groups, respectively were not significantly different. Nevertheless, in a multivariate analysis, the earlier incidence time of BPT considered as a time-dependent covariate was the only factor that independently influenced OS (hazard ratio = 0.99; 95% CI, 0.99-1.00; P = 0.002).

Conclusion: In Saudi Arabian adult HL patients, the risk of BPT and its effect on survival outcome were comparable to that reported from developed countries. Earlier incidence time of BPT aversely influenced OS. Future studies should consider testing the efficacy and safety of non-bleomycin-containing regimens in HL.