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J Oncol Pharm Pract. 2019 Oct;25(7):1638-1644. doi: 10.1177/1078155218804293. Epub 2018 Oct 14.

Risk of pulmonary toxicity of bleomycin and filgrastim.

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1 Department of Pharmacy, Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, site Hôtel-Dieu de Lévis, Lévis, Quebec, Canada.
2 Department of Pharmacy, Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec, site Centre hospitalier affilié universitaire régional de Trois-Rivières, Trois-Rivières, Quebec, Canada.
3 Faculté de Pharmacie, Université Laval, Quebec City, Quebec, Canada.
4 Population Health and Optimal Health Practices Unit, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada.



To estimate the relative risk of pulmonary toxicity in patients exposed to a bleomycin-based chemotherapy including filgrastim compared to a similar chemotherapy without filgrastim.


We conducted a nested case-control study of patients treated with BEP (bleomycin, etoposide and cisplatin) for germ cell cancer or with ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) for Hodgkin's lymphoma at the Hôtel-Dieu de Lévis Hospital between 31 October 2000 and 30 June 2016. The relative risk was estimated by an adjusted odds ratio (aOR) using a propensity score-adjusted regression analysis.


Thirteen cases of pulmonary toxicity, representing 14.7% of the 88 patients included in the study, were matched with 65 controls. A higher proportion of women (31.8%) than men (11.3%) developed pulmonary toxicity although the difference was not statistically significant (P = 0.08). Within the cohort, two deaths related to lung toxicity were observed among cases where no filgrastim was used. The risk of pulmonary toxicity associated with the addition of filgrastim was not statistically significant (aOR = 2.48 95% CI = 0.50 to 12.19).


The results add further evidence that the concomitant use of filgrastim might not increase the risk of pulmonary toxicity of bleomycin. It also suggests that female patients might be more likely to develop this adverse effect. A clinical trial would be needed to confirm this result.


Bleomycin; filgrastim; granulocyte colony stimulating factor; pulmonary toxicity


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