SERIAL PULMONARY-FUNCTION STUDIES IN CHILDREN TREATED FOR NEWLY-DIAGNOSED HODGKINS-DISEASE WITH MANTLE RADIOTHERAPY PLUS CYCLES OF CYCLOPHOSPHAMIDE, VINCRISTINE, AND PROCARBAZINE ALTERNATING WITH CYCLES OF DOXORUBICIN, BLEOMYCIN, VINBLASTINE, AND DACARBAZINE

Background. The pulmonary toxicity of bleomycin-containing chemotherap y combined with mantle radiotherapy in children treated for Hodgkin's disease was longitudinally assessed. Methods. The results of serial pu lmonary function studies in 37 children, newly diagnosed and treated a t St. Jude Children's Research Hospital between September 23, 1983, an d June 30, 1988, with cyclophosphamide, vincristine, and procarbazine (COP) alternating with doxorubicin, bleomycin, vinblastine, and dacarb azine (ABVD) plus low dose mantle radiotherapy are analyzed. All patie nts had pulmonary function studies at least before the first bleomycin dose, after completion of radiotherapy, and serially upon discontinua tion of therapy. Bleomycin therapy was withheld whenever measured carb on monoxide diffusing capacity was less than 50% of the predicted valu e. Results. Vital capacity, diffusing capacity, and diffusing capacity per unit of alveolar volume declined during the first 6 months of the rapy but improved thereafter. At 2 years postdiagnosis, diffusing capa city per unit of alveolar volume remained significantly reduced. Only one patient was symptomatic at the 2-year point. The survival rate of these patients was 95% at a median followup of 93 months. Conclusion. If bleomycin is withheld when diffusing capacity is diminished to 50% predicted, clinical compromise of pulmonary function appears to be min imal in pediatric patients receiving alternating cycles of COP/ABVD in combination with low-dose mantle radiotherapy. Survival was excellent , even with reduction of the total bleomycin dose.