Bleomycin-Induced Pulmonary Toxicity: A Systematic Review and Meta-Analysis of Incidence and Risk Factors.

Authors

Marie Tolstrup, Camilla Kjaer Lonkvist, Julie Gehl, Jakob Lauritsen

Published in

Critical reviews in oncology/hematology. Pages 105685. Nov 07, 2026. Epub Nov 07, 2026.

Abstract

Bleomycin remains an important component of curative regimens for malignancies such as germ cell tumors, Hodgkin lymphoma, and in the local treatment modality electrochemotherapy. A limiting toxicity is bleomycin-induced pulmonary toxicity (BIP), with considerable variance in reported incidence across studies.
To estimate the incidence of BIP after intravenous bleomycin treatment and investigate the influence of diagnostic definitions, patient characteristics, and treatment-related factors on reported incidence.
A systematic review and meta-analysis was conducted according to PRISMA 2020. MEDLINE, Embase, and Cochrane Library were searched through May 2026. Studies including patients aged ≥15 years treated with intravenous bleomycin were eligible. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Random-effects meta-analysis and prespecified subgroup analyses were performed.
A total of 65 studies comprising 7601 patients were included. The pooled incidence of BIP was 18% (95% CI 15-21%) with substantial between-study heterogeneity (I² = 87.3%). Reported incidence varied by diagnostic definition, ranging from 42% in imaging-based studies to 16% in studies using symptom-based composite definitions. Diagnostic definition explained a substantial proportion of between-study heterogeneity (R²=28%). No significant study-level associations were found between reported BIP incidence and age, sex, year of publication, overall cumulative bleomycin dose, use of granulocyte colony-stimulating factor, smoking history, or lung metastases.
Reported BIP incidence varies widely, largely due to differences in diagnostic definitions. Standardized, clinically meaningful diagnostic criteria are needed to improve comparability between studies and support evidence-based clinical decision-making.
PROSPERO (CRDxxxxxxxxxx).

PMID:
42998777
Bibliographic data and abstract were imported from PubMed on 08 Nov 2026.

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