Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc
Journal website https://www.thejh.org

Original Article

Volume 10, Number 6, December 2021, pages 266-273

Pulmonary Toxicity of Hodgkin Lymphoma Treatment: A Prospective Single-Center Study

Figures

Figure 1.
Figure 1. Intravenous bleomycin administration most significantly decreased DTPA clearance versus baseline. Intramuscular bleomycin administration lessened DTPA clearance decline. Patients who were not given bleomycin still experienced a significant decrease in DTPA clearance. DTPA: diethylenetriamine pentaacetic acid; IM: intramuscular; IV: intravenous.
Figure 2.
Figure 2. Scintigraphy results continuously worsened as cumulative bleomycin dose increased. DTPA: diethylenetriamine pentaacetic acid.
Figure 3.
Figure 3. (a) DLCO significantly worsened between staging and interim time points when all treatment modalities were applied except intramuscular administration; however, pulmonary function normalized by the restaging time point. (b) SGRQ scores decreased, and therefore, subjective patient symptoms generally improved throughout treatment. However, the differences were not significant. SGRQ: St. George Respiratory Questionnaire; DTPA: diethylenetriamine pentaacetic acid; DLCO: carbon monoxide diffusion capacity of the lung; Klco: transfer coefficient of the lung for carbon monoxide; IM: intramuscular; IV: intravenous.
Figure 4.
Figure 4. Mediastinal IFRT caused a significant degree of pulmonary toxicity. Findings evaluated via lung scintigraphy are shown. Changes observed in the no irradiation subgroup were greater than those observed in other groups. Changes in DLCO values were not significant. SGRQ scores decreased, and hence, subjective patient symptoms improved during treatment. Differences observed in the mediastinal irradiation group was significant. DTPA: diethylenetriamine pentaacetic acid; DLCO: carbon monoxide diffusion capacity of the lung; IFRT: involved-field irradiation therapy; Klco: transfer coefficient of the lung for carbon monoxide.
Figure 5.
Figure 5. Spirometry results that did not significantly change during treatment are shown. (a) No differences in terms of bleomycin administration and (b) the presence or absence of mediastinal irradiation were observed. Results are shown as percentages of age-matched healthy controls. TLC: total lung capacity; FVC: forced vital capacity; FEV1: forced expiratory volume; Tiffeneau index: FEV1/vital capacity.

Table

Table 1. Patient Characteristics
 
n (%)
Number of patients84
Age (years, median, range)35 (18 - 80)
Male40 (47.6%)
Female44 (52.4%)
Male/female0.91
B-symptoms44 (52.4%)
Histology
  cMC22 (26.2%)
  cNS49 (58.3%)
  cLR7 (8.3%)
  cLD1 (1.2%)
  ND5 (6.0%)
Stage
  I3 (3.6%)
  II34 (40.5%)
  III10 (11.9%)
  IV37 (44.0%)
Treatment
  ABVD71 (84.5%)
  BV-AVD12 (14.3%)
  EVD1 (1.2%)
  Mediastinal IFRT16 (19.0%)
Bleomycin administrationIMIVNo bleomycinP
cMC: classical mixed cellularity; cNS: classical nodular sclerosis; cLR: classical lymphocyte rich; cLD: classical lymphocyte depletion; ND: not determined; ABVD: doxorubicin, bleomycin, vinblastine, and dacarbazine; BV-AVD: brentuximab vedotin, doxorubicin, vinblastine, dacarbazine; EVD: epirubicin, vinblastine, dacarbazine; IFRT: involved-field irradiation therapy; IM: intramuscular; IV: intravenous; early/advanced: number and percentage of early stage and advanced stage patients; GFR: glomerular filtration rate; G-CSF: granulocyte colony-stimulating factor; ns: not significant.
n185313
Age (years, median)33 (20 - 54)36 (18-75)35 (20-80)ns
Early stage8 (44.4%)26 (49.1%)3 (23.1%)ns
Advanced stage10 (55.6%)27 (50.9%)10 (76.9%)
Bleomycin dose (mg/m2, median, range)120 (40 - 140)120 (40 - 120)0ns
Mediastinal IFRT9 (50%)5 (9.4%)2 (15.4%)0.0008
Renal function (median GFR, mL/min/1.73 m2)909090ns
Smoker8 (44.4%)15 (28.3%)7 (53.8%)ns
G-CSF use8 (44.4%)31 (58.5%)12 (92.3%)0.0230
Pulmonary involvement4 (22.2%)13 (24.5%)5 (38.5%)ns
Bulky disease10 (55.6%)9 (17.0%)4 (30.8%)0.0063