Bleomycin-induced Death Following ABVD Chemotherapy for Hodgkin’s Disease with Pulmonary Tuberculosis

OBJECTIVE Bleomycin (BLM) in ABVD regimen has a low therapeutic index. BLM-induced Death which we reported suggested that we should be cautious to use it. METHODS It was reported a 74-year-old Chinese man admitted to our hospital for fever, cough was diagnosed with classical Hodgkin’s disease with pulmonary tuberculosis. Doxorubicin, 35mg i.v., vinblastine, 4 mg i.v., dacarbazine 500 mg i.v., and BLM 15 mg i.v. were injected on the first day. RESULTS Twenty minutes after the BLM injection, the patient spiked a temperature to 41.0 ℃ with concomitant symptoms of dyspnea, hyperhidrosis and coma, and blood pressure dropped to 108/58 mmHg. The patient finally succumbed to multiple organ failure caused by BLM-induced toxicity. CONCLISION Chemotherapy regimen including BLM should be cautiously selected for the patients, especially patients >70 years old with pulmonary complication. It should be recommended that the empirical 1 unit test dose is administered after prophylactic agents. If no acute reaction occurs, recommended dosage regimen may then be administered.