The Role Of Hypertension And Renin-Angiotensin-Aldosterone System Inhibitors In Bleomycin-Induced Lung Injury

This study clarified the impact of hypertension and the administration of renin-angiotensin-aldosterone system inhibitors on the occurrence of bleomycin-induced lung injury (BLI). We retrospectively analyzed the data of 190 patients treated with bleomycin-containing chemotherapy. Age >= 65 years and a history of hypertension were significant factors for BLI onset. BLI occurrence was lower in patients who used renin-angiotensin-aldosterone system inhibitors.Introduction: The risk factors for bleomycin-induced lung injury (BLI), a fatal complication of cancer chemotherapy, are not well-established. The renin-angiotensin-aldosterone system (RAAS) has recently been suggested to play a role in the development of lung injury. This study clarified the impact of hypertension (HTN) and the administration of RAAS inhibitors on BLI occurrence in patients treated with bleomycin-containing regimens. Patients and Methods: We retrospectively analyzed the data of 190 patients treated with a bleomycin-containing regimen for Hodgkin lymphoma or germ cell tumors at our institutions from 2004 to 2018. Results: Overall, 190 patients received bleomycin, and symptomatic BLI occurred in 21 (11.1%) cases. In the multivariate analysis, age >= 65 years (odd ratio, 10.90; 95% confidence interval, 3.72-32.20; P < .001) and history of HTN (odds ratio, 3.32; 95% confidence interval, 1.07-10.30; P= .04) were found to be significant risk factors for BLI onset. BLI occurred in 3.6% (n = 5) of patients with no risk, 11.8% (n = 2) of those whose only risk factor was HTN, 31.6% (n = 6) of those whose only risk factor was age >= 65 years, and 57.1% (n = 8) of those with both risk factors (P < .001). BLI-induced mortality rates in each group were 0.0% (n = 0), 5.9% (n = 1),10.5% (n = 2), and 42.9% (n = 6)(P < .001), respectively. Among 31 patients with HTN, BLI incidence was 12.5% in patients who were administered RAAS inhibitors and 53.3% in those who were not (P = .02). Conclusion: Older age and history of HTN were independent risk factors for the development of BLI, and the administration of RAAS inhibitors might reduce the onset of BLI. (C) 2020 Elsevier Inc. All rights reserved.