Acute pulmonary toxicity following intralesional administration of bleomycin for a lymphovenous malformation

Atwa, Khalid; Abuhasna, Said; Shihab, Zuhair; Hashaykeh, Nidal; Hasan, Rashed A.

doi:10.1002/ppul.21139

Cited by 37 publications

(22 citation statements)

References 16 publications

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“…There has been one reported case of pulmonary toxicity following IBI in a lymphatic malformation in over 2600 patients in the literature [24]. This unit treats most patients with a dose of 0.5 mg/kg, which is in keeping with the published studies.…”

Section: Discussionsupporting

confidence: 56%

Intralesional bleomycin injection in management of low flow vascular malformations in children

Mohan

Adams²,

Adams³

et al. 2014

Journal of Plastic Surgery and Hand Surgery

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Low flow vascular malformations are challenging to manage, particularly with their propensity to grow, and can lead to severe disfigurement and dysfunction. Traditional surgical excision is fraught with tedious dissection and complications, particularly in the head and neck region. Trends toward less invasive techniques, such as intralesional sclerotherapy, are proving to be successful independent treatments or adjuncts in management in low flow vascular malformations. This study was a retrospective case note review, over an 8-year period, reporting the outcomes of 32 children (mean = 5.8 years, range = 5 months-11.5 years) with radiologically confirmed low flow vascular malformations, treated with serial intralesional bleomycin injection (IBI) therapy. Patient demographics, lesion characteristics, imaging findings, treatment course, radiological and clinical response to treatment were recorded. An overall 91% (n = 29) response rate was achieved, with 28% obtaining complete resolution for low flow vascular malformations. Lesions were sub-categorized into venous malformation, including mixed venous-capillary (n = 27) or lymphatic malformation (LM) (n = 5). Twenty-seven of 32 children experienced no complications. Local complications included superficial skin infection (n = 2), skin necrosis (n = 1), hyperpigmentation, and minor contour deformity. There was no recurrence and no systemic side-effects to bleomycin. Mean follow-up was 38 months (range = 6-95 months). In conclusion, serial intralesional bleomycin injections can be effective and also safe in a paediatric population for the successful management of symptomatic or disfiguring low flow vascular malformations.

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Section: Discussionsupporting

confidence: 56%

Intralesional bleomycin injection in management of low flow vascular malformations in children

Mohan

Adams²,

Adams³

et al. 2014

Journal of Plastic Surgery and Hand Surgery

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“…However, pulmonary pneumonitis and fibrosis are very rarely listed in the literature as complications of percutaneous bleomycin sclerotherapy. We are aware of two such reports . Both of these involved young children with small body surface area, which may indicate the need for a greater margin of safety in smaller people.…”

Section: Discussionmentioning

confidence: 99%

“…We are aware of two such reports. 52,53 Both of these involved young children with small body surface area, which may indicate the need for a greater margin of safety in smaller people.…”

Section: Bleomycin As a Sclerosant For The Treatment Of Symptomatic Vmsmentioning

confidence: 99%

Foamed bleomycin sclerosis of airway venous malformations: The role of interspecialty collaboration

et al. 2016

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“…39,49 A common institutional dose policy is 0.5 to 1 mg/kg with a single-session maximum dose of 15 mg. To date, no percutaneous sclerotherapy-associated cases of pulmonary fibrosis have been reported, although a single case of acute lung toxicity from bleomycin treatment of a vascular malformation has been reported. [50][51][52] A small prospective study of pediatric patients with microcystic LMs undergoing percutaneous bleomycin sclerotherapy showed no significant changes in chest radiography and pulmonary function tests 6 and 12 months following treatment, and abnormalities in diffusing capacity of the lungs for carbon monoxide and vital capacity have been described as most sensitive and specific for bleomycin-induced damage, respectively. 39 Importantly, because of the rarity of pulmonary complications associated with bleomycin sclerotherapy (with adherence to dose limits), it is not common practice to obtain preprocedure chest X-rays or pulmonary function tests.…”

Section: Bleomycinmentioning

confidence: 99%

The Role of Interventional Radiologists in the Treatment of Congenital Lymphatic Malformations

Cronan

Gill

Shah

et al. 2020

Semin intervent Radiol

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Lymphatic malformations are low-flow vascular malformations that are typically apparent in the pediatric population and can cause significant functional limitations and effects on quality of life. While surgical resection has historically been the mainstay of therapy, percutaneous sclerotherapy has garnered increasing popularity due to its efficacy and low complication rates. The role of interventional radiology in the multidisciplinary management of these often complex malformations requires thorough understanding of the disease process. This article will review the pathophysiology, clinical presentation, imaging workup, and management options of lymphatic malformations. Special attention will be devoted to available sclerosants, the mammalian target of rapamycin inhibitor sirolimus, and complex lymphatic anomalies.

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Acute pulmonary toxicity following intralesional administration of bleomycin for a lymphovenous malformation

Abstract: This case illustrates the importance of early recognition and aggressive treatment of acute bleomycin toxicity resulting from intralesional administration of this medication for lymphovenous malformations.

Cited by 37 publications

References 16 publications

Intralesional bleomycin injection in management of low flow vascular malformations in children

Intralesional bleomycin injection in management of low flow vascular malformations in children

Foamed bleomycin sclerosis of airway venous malformations: The role of interspecialty collaboration

The Role of Interventional Radiologists in the Treatment of Congenital Lymphatic Malformations

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