Bleomycin lung injury in children. Pathophysiology and guidelines for management

The development of pulmonary side effects, especially pulmonary fibrosis, during treatment with bleomycin is well documented in adult oncology patients, but not in children. A report of fatal pulmonary fibrosis which developed after exposure to oxygen while under anesthesia in a 3-year-old boy treated with bleomycin exemplifies the problem. The prevention of long-term complications associated with bleomycin is especially important in children, since a child cured of a malignant neoplasm may enjoy many years of productive life. Given the present limitations, guidelines for management of pediatric patients given bleomycin include: discontinuation of bleomycin therapy with the onset of symptoms; serial pulmonary function testing during the course of treatment; and early treatment with high-dose corticosteroids (prednisone 2 mg/kg/day) if symptoms occur.