Caution: bleomycin lung toxicity, especially with brentuximab or G-CSF
Bleomycin scars the lungs; combining it with brentuximab was fatal in early trials, and PET-adapted therapy now lets most patients skip it.
Brentuximab + ABVD caused 44% pulmonary toxicity with deaths in the phase 1 study, so ECHELON-1 used AVD. RATHL showed bleomycin can be dropped after a negative PET2. Bleomycin toxicity rises with age, renal impairment, G-CSF and oxygen exposure.
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