Pegfilgrastim Use and Risk of Bleomycin Induced Pulmonary Toxicity in Hodgkin Lymphoma

Background Filgrastim may increase the risk of bleomycin induced pulmonary toxicity (BPT) in Hodgkin lymphoma patients, particularly those >age 40 [

Methods: 38 cases of Hodgkin lymphoma treated with a bleomycin containing regimen were included in this analysis. 29 of these pts (Group A) also received pegfilgrastim and 9 pts (Group B) did not receive any growth factor support. All of the patients who received pegfilgrastim had it administered the day after chemotherapy and in all cases it was given to maintain dose intensity and prevent treatment delays. BPT was defined by the presence of pulmonary symptoms, interstitial infiltrates on chest x ray or computed tomography and the absence of infection.

Results: Grp A: 60% male, 40% female, mean age 39 (19 to 73), stage-I 2/29, II -14/29, III -5/29, IV-8/29; subtype- NS 20, MC 5, LP 3, LD 1. 27/29 received full dose ABVD (which included 10 units/m2 of bleomycin q 2weeks); one received ABD and one received full dose ABVD then had bleomycin held after 3 cycles. Mean number of cycles= 6 (4–8), median duration of treatment =160 days (71 to 231 days). Average ANC during treatment: 6590/mm3 (790 to 17273). Total # of bleomycin treatments: 274. Total # pegfilgrastim treatments: 203. Only 1/29 pts (age 44) developed BPT. There were no serious infections. Response to chemo: 22/29 CR, 5/29 PR, data not available in 2/29. At a median follow up of 18 months (range 4 to 48) 2/29 had relapsed. Grp B: 9 patients; mean age 39 (22 to 51), stage- II: 5/9; III: 4/9; subtype- NS 7, LP 2. All patients received full dose ABVD; ave # cycles= 6 (range 4–8), median duration of treatment= 145 days (30–220 days); average ANC during treatment: 2721/mm3 (2101 to 3535/mm3). Total # bleomycin treatments= 80. 1/9 pts (age 42) developed BPT. Response to chemo: 7/9 CR; 1 PR, 1 w/o response data. At a median follow up of 39 months (range 4–71), 2/9 relapsed.

Conclusions: In this small series, pegfilgrastim use with ABVD chemotherapy did not lead to a high risk of BPT in Hodgkin lymphoma, with only 1/29 patients (which included 203 treatments with both pegfilgrastim and bleomycin) developing BPT, as compared with 1/9 patients treated with ABVD and no pegfilgrastim. Both of the patients who developed BPT were >age 40. Larger studies will need to be performed to confirm our findings.