Serum creatinine level during chemotherapy for testicular cancer as a possible predictor of bleomycin-induced pulmonary toxicity

BACKGROUND: Bleomycin is one of the key drugs used in inductionchemotherapy for testicular cancer. Pulmonary toxicity is the major andpotentially fatal adverse side-effect of this drug. METHODS: To evaluatethe risk factors for bleomycin pulmonary toxicity, we retrospectivelyanalyzed the cases of 20 men treated for metastatic testicular cancer atTsukuba University Hospital between 1990 and 1996. All patients weretreated with two to four cycles of a PVB regimen or BEP regimen.Recombinant human granulocyte colony-stimulating factor was used in all butone case. With a logistic procedure, we evaluated the age, total bleomycindose, total cisplatin dose, renal injury, leukocytosis, smoking history,lung metastases and drug regimen as risk factors for a decrease in thediffusing capacity. RESULTS: Diffusing capacity was decreased to below 75%of the predicted values in nine patients. Elevation of the serum creatininelevel was the most significant risk factor (P = 0.018) by the chi-squaredtest. A logistic regression analysis also indicated that the elevation ofserum creatinine level was an independent risk factor for a decrease in thediffusing capacity (odds ratio 22.3, 95% Cl 1.02-487.3, P = 0.049).CONCLUSIONS: We recommend a pulmonary function assessment of patientsreceiving a relatively low dose of bleomycin, especially when an elevatedserum creatinine level is seen during chemotherapy.