Caution: bleomycin lung toxicity, especially with brentuximab or G-CSF

Bleomycin scars the lungs, and this caution pairing warns that the risk is compounded when it is combined with brentuximab vedotin or given alongside G-CSF. In the phase 1 study of brentuximab plus ABVD, pulmonary toxicity was frequent and some patients died, so the phase 3 ECHELON-1 trial dropped bleomycin and used brentuximab with AVD. The RATHL trial showed that bleomycin can be omitted after a negative interim PET scan, so PET-adapted therapy now lets most patients with Hodgkin lymphoma avoid it; the rationale is additive pneumotoxicity and the small contribution bleomycin makes once PET2 is negative. Toxicity also rises with age, renal impairment, G-CSF and oxygen exposure, and the record is also linked from the record on germ cell tumours of childhood and adolescence.