Muhammad Abdullah, Shoaib Alam, Waleed Zafar, Abdul Majid


Background: Chemotherapy consisting of Adriamycin, Bleomycin, Vinblastine, and Doxorubicin (ABVD), which is the mainstay of treatment in Hodgkin’s Lymphoma (HL), is associated with both acute and long-term pulmonary toxicity primarily due to Bleomycin. Bleomycin induced pulmonary toxicity (BPT) is clinically detected using diffusing lung capacity for carbon monoxide (DLCO). The objective of this study was to evaluate changes in DLCO in HL patients before and after ABVD chemotherapy. Methods: Medical records of all adult HL patients treated with ABVD chemotherapy at a single centre in Lahore, Pakistan during the entire calendar year 2012 were analysed. Patients with pre-existing pulmonary dysfunction, history of thoracic surgery and smokers were excluded. Results:  A total of 179 HL patients were identified during the study period who received ABVD chemotherapy. Out of these, 93 (51.95%) patients had undergone both a pre- and post-chemotherapy DLCO measurements. The remaining patients had only one DLCO reading available and were not included in the analysis. The mean percentage difference between pre- and post-chemotherapy values for DLCO (5.49%; 95% confidence interval [CI] 1.56–9.43%) and for Haemoglobin-adjusted DLCO (8.24%; 95% CI 3.90–12.57%) were statistically significant at p<0.01. Diffusing lung capacity for carbon (DLCO) values declined from pre-treatment to post-treatment by 1–10% in 23 (24.7%) patients, by 10–20% in 19 (20.4%) patients, by 20–30% in 10 (10.8%) patients and >30% in 10 (10.8%) patients. After adjusting for age, a 1mg/m2 increase in dose of Bleomycin was significantly associated with 0.14%  (95% CI: 0.03–0.25%) decline in DLCO and 0.13% (95% CI: 0.10–0.26%) decline in haemoglobin-adjusted DLCO from pre-treatment value. Conclusions: Mild to moderate dysfunction in diffusion lung capacity is common after ABVD chemotherapy. DLCO and haemoglobin-adjusted DLCO value decreased with increasing age and increasing dose of Bleomycin.

Keywords: Hodgkin’s Lymphoma, chemotherapy, diffusion lung capacity, Pakistan, cancer


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