INTRAPLEURAL BLEOMYCIN IN THE TREATMENT OF CHYLOTHORAX

Chylothorax is an accumulation of thoracic lymph or chyle in the pleur al cavity. It is a rare condition and is usually caused by trauma or m alignant disease. We present three cases with chylothorax due to malig nant non-Hodgkin's lymphoma {high grade malignant (1 case) and low gra de malignant (2 cases)} treated with pleurodesis with bleomycin and sy stemic chemotherapy (CHOP, CNOP, trofosfamide). Complete remissions (C R) were achieved in all three cases. Two patients had a recurrent chyl othorax 3 and 12 months after initial treatment. They were treated wit h a second intrapleural installation of bleomycin and continuing syste mic chemotherapy (CNOP, trofosfamide) and are still alive in CR with a follow-up period of 28 and 30 months respectively. One patient died o f relapsing non-Hodgkin's lymphoma after 23 months of follow-up. There was no sign of recurrent chylothorax. We conclude that chylothorax ca used by lymphoma can be satisfactorily controlled by pleurodesis with bleomycin combined with systemic chemotherapy. Immediate action is nec essary to prevent great loss of lipids and proteins. The underlying ma lignancy must be controlled to achieve a good prognosis.