Can We Predict Bleomycin Toxicity with PET-CT?

AIM: Bleomycin is an antitumor antibiotic used successfully to treat a variety of malignancies, predominantly germ cell tumors and Hodgkin's lymphoma (HL). The major limitation of bleomycin therapy is the potential for life-threatening interstitial pulmonary fibrosis. Early identification of asymptomatic patients who may develop toxicity is important. We aimed to evaluate fluorodeoxyglucose positron-emission tomography (FDG-PET/CT) findings to predict bleomycin toxicity (BT) early after chemotherapy with doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy before clinical symptoms and radiological changes occur. MATERIALS AND METHODS: HL patients who were treated with ABVD were evaluated. SUVmax values of lung parenchyma were analyzed in FDG-PET/CT at diagnosis and after 4 cycles of chemotherapy in all patients. At the end of the chemotherapy cycles, lung parenchymal SUVmax values of patients with BT and without BT were compared statistically. RESULTS: Twenty (66.7%) male and 10 (33.3%) female patients with HL were included. Five (16.7%) HL patients developed BT. In 3 HL patients, BT was determined after 5 cycles and in 2 patients, BT was seen after 6 cycles. In all 5 of these patients with BT, FDG uptake in PET-CT was increased after 4 cycles of chemotherapy and BT was predicted before clinical and radiological findings by FDG-PET/CT. After 4 cycles of chemotherapy, lung parenchymal SUVmax of patients with BT (3.24 ± 0.76) was significantly higher than in patients without toxicity (1.84 ± 0.52) (p < 0.001). In patients with BT, a significant increase was established in lung parenchymal SUVmax after 4 cycles of chemotherapy when compared to the time of diagnosis (p = 0.043). CONCLUSION: BT can be fatal. Early detection of BT is essential in clinical practice. FDG-PET/CT can predict BT before clinical and radiological findings occur.

Asociación del déficit grave de vitamina D con la función pulmonar y el control del asma / Association between severe Vitamin D deficiency, lung function and asthma control

Introducción: Examinar la relación existente entre el déficit grave de vitamina D, el control del asma y la función pulmonar en adultos turcos asmáticos. Métodos: Ciento 6 pacientes asmáticos se sometieron a pruebas de función pulmonar, pruebas intraepidérmicas y determinaciones de eosinófilos en sangre periférica, IgE, índice de masa corporal y concentraciones de vitamina D. Las concentraciones de vitamina D se dividieron en 2 grupos (concentración de vitamina D < 10 ng/ml y ≥ 10 ng/ml). Se practicaron pruebas de control del asma. Resultados: La media de edad de los pacientes fue de 37 ± 10 años en el primer grupo (concentración de vitamina D < 10 ng/ml) y de 34 ± 8 años en el segundo (concentración de vitamina D ≥ 10 ng/ml). Un 66% de los pacientes presentaban déficit grave de vitamina D (concentración de vitamina D < 10 ng/ml). Los pacientes con concentraciones bajas de vitamina D mostraron una tendencia significativa a presentar valores absolutos más bajos de FEV1 (l) (p = 0,001). Las puntuaciones de las pruebas de control del asma fueron significativamente más bajas en el grupo con déficit grave de vitamina D que en el segundo grupo (p = 0,02). En el grupo con déficit grave, hubo un mayor número de pacientes con asma incontrolada (puntuaciones de las pruebas de control del asma < 20) (p = 0,040). Los pacientes con déficit grave de vitamina D habían utilizado muchos más corticoides inhalados que los que no presentaban déficit grave (p = 0,015). En los pacientes con concentraciones más bajas de vitamina D se observó una tendencia significativa a presentar valores absolutos más bajos de FEV1 (l) (p = 0,005; r = 0,272). Se observó una relación inversa entre las concentraciones de vitamina D y el índice de masa corporal (p = 0,046). Conclusión: La incidencia de déficit grave de vitamina D fue elevada en adultos asmáticos turcos. Además, las concentraciones más bajas de vitamina D se asociaron con descensos del control del asma y de la función pulmonar

Introduction: To examine the relationship between severe vitamin D deficiency, asthma control, and pulmonary function in Turkish adults with asthma. Methods: One hundred six asthmatic patients underwent pulmonary function tests skin prick test, peripheral blood eosinophil counts, IgE, body mass index and vitamin D levels were determined. Patients were divided into 2 subgroups according to vitamin D levels (vitamin D level < 10 ng/ml and vitamin D level ≥ 10 ng/ml). Asthma control tests were performed. Results: The mean age of subgroup i (vitamin D level < 10) was 37 ± 10 and the mean age of subgroup II (vitamin D level ≥ 10 ng/ml) was 34 ± 8. Sixty-six percent of patients had severe vitamin D deficiency (vitamin D level < 10 ng/ml). There was a significant trend towards lower absolute FEV1 (L) values in patients with lower vitamin D levels (P = .001). Asthma control test scores were significantly low in the severe deficiency group than the other group (P = .02). There were a greater number of patients with uncontrolled asthma (asthma control test scores < 20) in the severe vitamin D deficiency group (P = .040). Patients with severe vitamin D deficiency had a higher usage of inhaled corticosteroids than the group without severe vitamin D deficiency (P = .015). There was a significant trend towards lower absolute FEV1 (L) (P = .005, r = .272) values in patients with lower vitamin D levels. Vitamin D levels were inversely related with body mass index (P = .046). Conclusion: The incidence of severe vitamin D deficiency was high in adult Turkish asthmatics. In addition, lower vitamin D levels were associated with poor asthma control and decreased pulmonary function

Association Between Severe Vitamin D Deficiency, Lung Function and Asthma Control. / Asociación del déficit grave de vitamina D con la función pulmonar y el control del asma.

INTRODUCTION: To examine the relationship between severe vitamin D deficiency, asthma control, and pulmonary function in Turkish adults with asthma. METHODS: One hundred six asthmatic patients underwent pulmonary function tests skin prick test, peripheral blood eosinophil counts, IgE, body mass index and vitamin D levels were determined. Patients were divided into 2 subgroups according to vitamin D levels (vitamin D level<10ng/ml and vitamin D level≥10 ng/ml). Asthma control tests were performed. RESULTS: The mean age of subgroup i (vitamin D level<10) was 37±10 and the mean age of subgroup ii (vitamin D level≥10ng/ml) was 34±8. Sixty-six percent of patients had severe vitamin D deficiency (vitamin D level<10 ng/ml). There was a significant trend towards lower absolute FEV1 (L) values in patients with lower vitamin D levels (P=.001). Asthma control test scores were significantly low in the severe deficiency group than the other group (P=.02). There were a greater number of patients with uncontrolled asthma (asthma control test scores<20) in the severe vitamin D deficiency group (P=.040). Patients with severe vitamin D deficiency had a higher usage of inhaled corticosteroids than the group without severe vitamin D deficiency (P=.015). There was a significant trend towards lower absolute FEV1 (L) (P=.005, r=.272) values in patients with lower vitamin D levels. Vitamin D levels were inversely related with body mass index (P=.046). CONCLUSION: The incidence of severe vitamin D deficiency was high in adult Turkish asthmatics. In addition, lower vitamin D levels were associated with poor asthma control and decreased pulmonary function.