Fatal Lung Toxicity After Intralesional Bleomycin Sclerotherapy of a Vascular Malformation

Cho, Alexander L.; Kiang, Sharon C.; Lodenkamp, Jonathan; Tritch, William T. H.; Tomihama, Roger T.

doi:10.1007/s00270-020-02420-w

Cited by 23 publications

(7 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[21][22][23] There has been a single report on fatal lung toxicity in a 15-month-old girl 1 week after injection of 7 units of bleomycin into a cheek macrocystic LM. 24 In the present study, adverse reactions noted were inflammation in 7 (29%) and transient hyperpigmentation in 12 (50%) of the patients. No long-term side effects occurred in any of the patients.…”

Section: Discussionsupporting

confidence: 48%

Intralesional Bleomycin for Orbital Lymphatic Malformations: Comparison of Clinical Versus Radiologic Regression by Volumetric Analysis

Dave¹,

Madhuri²,

Kaliki

2021

Ophthalmic Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

Purpose: The aim of the study was to investigate the clinical resolution versus radiologic regression of orbital lymphatic malformations (LMs) following treatment with intralesional bleomycin sulfate sclerotherapy. Methods: A retrospective interventional study of 24 eyes with orbital LMs treated with nonimage-guided bleomycin sclerotherapy. The clinical and radiologic outcomes were classified as excellent, good, fair, and poor. Regression was assessed clinically and by radiologic volumetrics. Results: Mean age at presentation was 17 ± 18 years (median 11, range 5 months to 70 years). Lesion morphology was microcystic in 11 (46%), macrocystic in 8 (34%), and mixed in 5 (21%) eyes. Mean units of bleomycin injected per session were 4 ± 2 IU (median 5 IU, range 1–6 IU). Mean number of treatment sessions required was 2 ± 1 (median 2, range 1–6). Cumulative units of bleomycin injected were 11 ± 9 (median 9, range 1–38 IU). The clinical response was excellent in 19 (79%), good in 4 (17%), and fair in 1 (4%). The mean preoperative and postoperative lesion volumes were 7 ± 4 cm3 and 0.8 ± 1.2 cm3, respectively (p < 0.0001, 95% CI, −7.89 to −4.51). Radiologic resolution of LM was excellent in 6 (25%), good in 8 (33%), fair in 7 (29%), and poor in 3 (13%) eyes. Spearman’s rank correlation coefficient for correlation between clinical and radiologic grading was 0.51 (p = 0.01, 95% CI, 0.13–0.75%). There was a sustained tumor resolution without recurrence over a mean follow-up duration was 2 years (median 18 months; range 12–60 months). Conclusions: Bleomycin sclerotherapy for orbital LMs gives an excellent to good clinical response in 93%. However, a parallel radiologic regression is seen only in 58%. The endpoint to assess response should be clinical. Treatment till complete radiologic resolution may not be necessary.

show abstract

Section: Discussionsupporting

confidence: 48%

Intralesional Bleomycin for Orbital Lymphatic Malformations: Comparison of Clinical Versus Radiologic Regression by Volumetric Analysis

Dave¹,

Madhuri²,

Kaliki

2021

Ophthalmic Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

show abstract

“…By binding to the DNA of lymphatic endothelial cells (LECs), bleomycin inhibited DNA synthesis, cut DNA strands, damaged endothelial cells, thickened walls, narrowed the lumen, and eventually caused focal atrophy. However, bleomycin has dose-dependent pulmonary toxicity, and there is a risk of pulmonary fibrosis when the cumulative dose exceeds 160 mg. 24 Therefore, in this study, the cumulative dose of bleomycin did not exceed 15 mg. As a result, there was no pulmonary toxicity-related side effects. Simultaneously, lauromacrogol, a secondary sclerosing agent, was combined with bleomycin to destroy the cell membrane of LECs, cause organ fibrosis, prolong the action time of bleomycin in the lesion, reduce the amount of bleomycin, and accelerate luminal occlusion and lesion atrophy.…”

Section: Discussionmentioning

confidence: 90%

Sclerotherapy in Lymphatic Malformations with Intralesional Hemorrhage: A Retrospective Comparison with Non-Hemorrhagic Lymphatic Malformations

Wang¹,

Liu²,

Long³

et al. 2022

CCID

View full text Add to dashboard Cite

To compare the outcomes of sclerotherapy with bleomycin and lauromacrogol between lymphatic malformations (LM) with and without intralesional hemorrhage and identify the factors affecting the outcomes of LM with hemorrhage. Patients and Methods: This retrospective study examined patients with LM who underwent sclerotherapy with bleomycin and lauromacrogol between January 2019 and December 2021. Regression models were used to analyze the factors associated with the outcomes of LM with hemorrhage. Results: 52 patients were included in the study, including 26 with intralesional hemorrhage. Masses with bluish skin (p = 0.026) and pain (p = 0.001) were more common in LM with hemorrhage. With similar outcomes, the average number of sessions was 2.9 in LM with hemorrhage and 2 in LM without hemorrhage (p = 0.028). The efficacies of the macrocystic and mixed types (93.3% and 83.3%, respectively) were higher than that of the microcystic type (40%) (p = 0.036). As the number of sessions increased, the relapse rate decreased (p = 0.018). Conclusion: Sclerotherapy with bleomycin and lauromacrogol is effective and safe for LM with hemorrhage. An increased number of injections for patients with hemorrhage was associated with similar efficacy for those without hemorrhage and similar relapse rates.

show abstract

“…The most worrisome side-effect is pulmonary toxicity, which is less likely to occur in the doses used for sclerotherapy, occurring most commonly during its use in oncologic practice. However, anecdotal reports have noted this rare, non-immunologically mediated adverse effect after its use for sclerotherapy [12,13]. There have also been anecdotal reports of acute adverse effects including hyperpyrexia, hypotension, altered mental status, and respiratory distress during the administration of bleomycin for chemotherapy in oncology patients [11,14].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Anaphylaxis Following Injection of a Bleomycin-Gelatin Solution for Sclerotherapy

et al. 2022

View full text Add to dashboard Cite

During the perioperative period, the most commonly identified agents that are responsible for acute allergic reactions include antibiotics, neuromuscular blocking agents, opioids, chlorhexidine, and iodinated dyes for radiologic imaging. However, whenever an allergic reaction is suspected, all of the agents to which the patient has been exposed must be considered. Although bleomycin is utilized as the primary agent for sclerotherapy in the treatment of vascular malformations, other substances such as Surgiflo ® may be added to the bleomycin solution to increase its efficacy and promote thrombosis of the smaller vessels. These products are derived from animal collagen and contain gelatin which may lead to an allergic reaction. We present an 11-year-old girl undergoing sclerotherapy treatment of an extensive left lower extremity venous malformation who subsequently developed perioperative hemodynamic instability requiring intervention after receiving an injection of a bleomycin and Surgiflo ® solution. Further investigation identified gelatin in the Surgiflo ® as the causative agent of the allergic event. Previous reports of such reactions are reviewed and the perioperative care and treatment of patients who experience anaphylaxis is addressed.

show abstract

Fatal Lung Toxicity After Intralesional Bleomycin Sclerotherapy of a Vascular Malformation

Cited by 23 publications

References 10 publications

Intralesional Bleomycin for Orbital Lymphatic Malformations: Comparison of Clinical Versus Radiologic Regression by Volumetric Analysis

Intralesional Bleomycin for Orbital Lymphatic Malformations: Comparison of Clinical Versus Radiologic Regression by Volumetric Analysis

Sclerotherapy in Lymphatic Malformations with Intralesional Hemorrhage: A Retrospective Comparison with Non-Hemorrhagic Lymphatic Malformations

Intraoperative Anaphylaxis Following Injection of a Bleomycin-Gelatin Solution for Sclerotherapy

Contact Info

Product

Resources

About