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Hodgkin's lymphoma

Hodgkin's lymphoma. Louise Gribben Haematology CNS HAI 2016. Case study. 61 year old female HD on ABVD chemotherapy 6 th and final ABVD 9 th October Help line call same day Pyrexia, rigors ?bleomycin reaction Developed hacking cough, hypoxic Not neutropenic. …. …. …. ….

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Hodgkin's lymphoma

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  1. Hodgkin's lymphoma Louise Gribben Haematology CNS HAI 2016

  2. Case study • 61 year old female • HD on ABVD chemotherapy • 6th and final ABVD 9th October • Help line call same day • Pyrexia, rigors ?bleomycin reaction • Developed hacking cough, hypoxic • Not neutropenic

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  5. Deterioration over 1 week • Broad spectrum anti bacterials • Increasing SOB • No evidence for infective process • Increasing oxygen requirements • High dose Co-trimoxazole/steroids

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  7. ICU (day 7 post admission) • Type 1 respiratory failure/ fibrotic changes • Intubated/ ventilated • Probable BIP • Deceased ( day 18 post admission)

  8. Bleomycin Induced Pneumonitis and Fibrosis Duggan et al 2003 28% of HD ĉ ABVD 224 of 814 patients Martin et al 2005 18% of HD ĉ ABVD 25 of 141 patients 5 died

  9. Side effects • Fever, chills, hypotension • Dermal pigmentation, fibrosis • Stomatitis • Fatigue • Pulmonary toxicity • Bronchiolitis obliterans with organizing pneumonia • Interstitial pneumonitis with progression to fibrosis • Death – 3%

  10. BIP – Clinical Features Initial • Non productive cough • Exertional dyspnoea • Sometimes fever Progressive • Dyspnoea at rest • Tachynoea • Cyanosis On examination – fine basal creps, progress to rhonchi sometimes pleural rub

  11. Treatment • Exclude infection • Corticosteroid • Stop Bleomycin • In survivors, pulmonary symptoms and lung function normalise in time

  12. Adjusted management • Specific ABVD prescription charts. • Drug specific counselling/consent forms. • Pre chemo exercise/oximetry testing • Repeated PFT pre each treatment after cycle 3 • Avoid use of GCSF products • Caution with O2 therapy

  13. In Future Avoid/ Reduce Bleomycin in regimen Nice guidance PET scan can distinguish active inflammation and lung damage

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