Should Bleomycin test dosing still be performed?

Introduction: The last published report of a bleomycin hypersensitivity reaction was printed approximately 27 years ago. As a result, speculation about the need for bleomycin test dosing is common fodder for debate among hematology/oncology pharmacists. Theories have promulgated that the bleomycin manufacturing process has been refined or the enhanced present-day utilization of acetaminophen, corticosteroids and diphenhydramine pre-medications may be limiting the incidence of hypersensitivity reactions. Objectives: Our aim was to determine if the test dose was an accurate predictor of the risk of hypersensitivity reaction. The secondary endpoint was to determine if removal of bleomycin test doses resulted in any increased risk of hypersensitivity reactions to our patients. Study Design: A retrospective review was conducted to evaluate the incidence of hypersensitivity reactions before and after the practice change of requiring a test dose be performed. Methods: Patients were included in the study if they were greater than 18 years old and had received any dose of bleomycin as documented on the medication administration record (MAR). Extracted information included the bleomycin regimen, pre-medications administered before the bleomycin dose, patient demographic and the nature of the hypersensitivity reaction if one occurred. The incidence of bleomycin hypersensitivity reactions was recorded for a 12 month interval prior to the practice change and followed for a 12 month time period post practice change. Results: Pending finalization. Conclusions: Given that bleomycin test dosing is not a reliable predictor of patients who may develop hypersensitivity reactions, bleomycin test doses should no longer be performed.