FRI0272 Evaluation of Bleomycin Induced Raynaud's Phenomenon and Systemic Sclerosis Vasculopathy in Germ Cell Tumour Patients. (15th July 2016)

• Record Type: Journal Article
• Authors: Faulkner, D.; Britton, J.; Eng, S.; Del Galdo, F.; Stark, D.; Buch, M.
• Is Part Of: Annals of the rheumatic diseases. Volume 75(2016)Supplement 2
• Page Start: 533
• Page End: 534
• Publication Date: 2016-07-15
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2016-eular.1826
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Bleomycin forms part of the chemotherapy regimen ("BEP") for germ cell testicular cancer (1). The drug is known to cause Raynaud's phenomenon (RP) in up to 25% of men who receive the BEP regime (2). RP is also a feature of systemic sclerosis (SSc), a connective tissue disease that is studied in a mouse model using bleomycin as the agent to induce pulmonary fibrosis (3, 4). There have been isolated cases where patients, treated for lymphoma with bleomycin containing regimens, have developed SSc (5, 6) thus evaluation of RP and SSc is warranted in testicular cancer patients. Objectives: In men with germ cell testicular cancer who have received BEP in Leeds: 1) Evaluate the prevalence, nature, and onset of RP. 2) Compare the characteristics of those that developed RP with those that did not. 3) Determine whether those reporting RP have microvascular features of SSc. Methods: A patient questionnaire completed retrospectively by men receiving follow up post BEP treatment was used to collect data on the prevalence, nature, and onset of RP. A subset of patients reporting RP then underwent capillaroscopy and thermography. Results: 24 eligible men completed the questionnaire. RP was prevalent in 13 of the men (54% CI 0.34–0.74), usually bilaterally (92%) and accompanied by sensory disturbance (92%). Onset was most commonly reported to be following chemotherapy completion (77%). There was no association between RP and marital status, smoking status, tumour type or total bleomycin dose (p values >0.05). No evidence was found to suggest SSc in the patients who underwent capillaroscopy and thermography. Hallmark capillary changes indicative of SSc were absent at the nailbed. The mean (SD) recovery of the fingers back to baseline temperature was 93.8 (14.57)% at ten minutes post cold challenge and the mean (SD) re-warming rate of the fingers was 0.925 (0.17) °C/minute. Conclusions: The prevalence of RP in this patient group was higher than expected. The absence of SSc vasculopathy was reassuring, however not all of the men reporting RP underwent Rheumatology assessment. The retrospective nature and small sample size of this study are key limitations but our findings justify further prospective evaluation of the prevalence and the basis for bleomycin-associated RP. References: Horwich A, Nicol D, Huddart R. Testicular germ cell tumours. BMJ 2013; 347: f5526 doi: 10.1136/bmj.f5526. Bokemeyer C, Berger C C, Kuczyk M A, Schmoll H. Evaluation of Long-Term Toxicity After Chemotherapy for Testicular Cancer. Journal of Clinical Oncology 1996; 14: 2923–2932. Lakos G, Takagawa S, Varga J. Animal Models of Scleroderma. In: Perl A. Ed. Methods in Molecular Medicine, Vol. 102: Autoimunity: Methods and Protocols. 2004. Humana Press Inc., Totowa, NJ. 377–393. Matucci-Cerinic M, Kahaleh B, Wigley F M. Evidence That Systemic Sclerosis Is a Vascular Disease. Arthritis & Rheumatism 2013; 65(8): 1953–1962. Passiu G, Cauli A, Atzeni F, et al. Bleomycin-induced Scleroderma: Report of a Case with a Chronic Course Rather Than the Typical Acute/Subacute Self-Limiting Form. Clinical Rheumatology 1999; 18: 422–424. Kin K H, Yoon T J, Oh C W, Ko G H, Kim T H. A Case of Bleomyin-induced Scleroderma. Journal of Korean Medical Science 1996; 11(5): 454–456. Disclosure of Interest: None declared