pairingsPairing
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.
Rationale
Additive pneumotoxicity; bleomycin adds little efficacy once PET2 is negative.
Evidence
Phase 1 toxicity signal; RATHL phase 3 non-inferiority.