Intralesional bleomycin injection (IBI) treatment for haemangiomas and congenital vascular malformations

Abstract

Successful treatment of vascular anomalies has eluded the physician until now, despite various treatments utilised. Bleomycin has been successfully used in intralesional injection treatment of cystic hygromas and haemangiomas, based specifically on a high sclerosing effect on vascular endothelium. In a prospective study of 95 patients, the effectiveness of intralesional bleomycin injection (IBI) treatment in haemangiomas and vascular malformations was evaluated and documented. Complete resolution or significant improvement occurred in 80% of all patients treated. Complete resolution occurred in 49% of haemangiomas, 32% of venous malformations, and 80% of cystic hygromas. Significant improvement occurred in 38% of haemangiomas, 52% of venous malformations, 13% of cystic hygromas and 50% of lymphatic malformations. Of the six patients who presented with a painful lesion, four experienced complete resolution and two had significant improvement to treatment. Local complications encountered were superficial ulceration occurring in 2 patients, and cellulitis in 1 of the 95 patients. Systemic complications were flu-like symptoms in three patients and partial, transient hair loss in two patients. None of the patients presented with haematological toxic effects or signs of pulmonary involvement (fibrosis, hypertension). IBI is an effective treatment in haemangiomas and vascular malformation lesions, obviating the need for invasive primary surgery or systemic treatment regimens in 80% of cases, and allowing for limited need of secondary surgical or adjunctive procedures in cases with a moderate result.

Comparative Analysis of Intralesional Sclerotherapy with Sodium Tetradecyl Sulfate Versus Bleomycin in the Management of Low Flow Craniofacial Soft Tissue Vascular Lesions

“…The drug has no immunosuppressive activity in mice. T Muir and associates reported a response rate of 98% with no systemic or pulmonary complication; they used a maximum dose of 3 mg/kg of body weight [18]. J. W. Zheng and Z. Y. Zhang [19] reviewed various modalities of sclerotherapy and emphasized on multidisciplinary approach to treat vascular malformation.…”

Percutaneous Sclerotherapy for Facial Venous Malformations: Subjective Clinical and Objective MR Imaging Follow-Up Results

“…1 Bleomycin is a cytotoxic antitumor agent, whose sclerosing effect on endothelial cells was applied by Muir et al to the treatment of venous malformations and hemangiomas. 7 Since this initial report, a number of studies have been published, supporting both the treatment efficacy and relatively low complication rate. [7][8][9] As it produces only minimal swelling after sclerotherapy (as opposed to ethanol-based agents), bleomycin is especially recommended for treatment of vulnerable areas such as the periorbit or regions related to the airway (ie, tongue and parapharyngeal spaces).…”

Malformaciones linfáticas: tratamiento percutáneo con bleomicina

“…Las dosis recomendadas por sesión oscilan entre 0,3-1 mg/kg, con una dosis máxima de 15 mg por sesión. [17][18][19][20][21][22] Las complicaciones descriptas con el uso de bleomicina intralesional son raras, 13,[17][18][19][20][21][22][23][24] y pueden ser locales (eritema, celulitis, ulceración, estrías, hiperqueratosis e hiperpigmentación local o distante) o sistémicas (hipertermia, anorexia, náu-seas, vómitos, diarrea, caída parcial y transitoria del cabello, prurito y onicólisis.…”