Shelly,
Thanks for your questions. Bleomycin Sulfate (Blenoxane®, Blenomax®) - Bleomycin is a polypeptide which fights against a number of tumors. The exact mechanisms of action of this drug are not clear; however, its cytotoxic effects are likely mediated through inhibition of cell cycle progression and the synthesis of DNA and protein. The primary dose-limiting toxicity of Bleomycin is the development of pulmonary toxicity ranging from radiographic changes to pneumonitis and fatal pulmonary fibrosis. Controversy has surrounded the use of supplemental oxygen administration and perioperative patients who have received Bleomycin chemotherapy since 1978 due to oxygen-related risk to severe pulmonary complications. Despite the theoretical risk, there are no articles specifically stating that HBO should be prohibited after bleomycin administration. As late as 2008, prior bleomycin remained an absolute contraindication to HBO therapy. [1]

The UHMS Safety Committee posted the following response to a MEDFAQ question regarding Bleomycin and hyperbaric Oxygen therapy, originally published August 2, 2015: “The UHMS is unable to provide a stance on Bleomycin being a contraindication to hyperbaric oxygen therapy. As always, this is the treating physician's decision. There is no definitive study on this topic, however Duke University published an article on their research. Prudence would mandate a consult with a pulmonologist with PFTs and the patient’s oncologist. Factors influencing toxicity include patient's age at time of Bleomycin, dose and time since treatment”. [2]

Klaus et al reported a case series fourteen Bleomycin exposed patients receiving hyperbaric oxygen therapy at Duke Center for Hyperbaric Medicine and Environmental Physiology from 1979 to 2010. Fourteen bleomycin-exposed patients received HBO2 at Duke under a special-precautions protocol. One was treated for DCS elsewhere. The protocol included: pre-treatment evaluation; chest radiograph; spirometry; blood gases; a single, 2-atmospheres absolute (atm abs),120-minute HBO2 treatment; and a gradual acceleration over one week to a twice-daily schedule contingent on clinical and laboratory findings. Median bleomycin-to-HBO2 latency was 34 months (range 1-279). Three patients received HBO2 within six months, and seven patients received HBO2 within two years of their last bleomycin exposure. There were no adverse pre-to-post HBO2 changes in: arterial blood gases, spirometry, chest radiograph findings or clinical reports. There were no persistent post-HBO2 pulmonary complications on follow-up. Post-HBO2 data were available for 40%, 53%, 87%and 100% of these parameters respectively. Bleomycin and oxygen can individually cause acute pulmonary toxicity. However, evidence for increased long-term susceptibility based on their synergy may be overstated. [4]


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Reference
1. Hamm T, Mize J, Worth E, (2019). "Medications In The Hyperbaric Environment". In (Eds.) , WoundReference. Available from: https://woundreference.com/app/topic?id=medications-in-the-hyperbaric-environment. Retrieved on 4/15/22.
2. UHMS.orghttps://www.uhms.org/resources/medfaqs-frequently-asked-questions-faq/search/1-%20Search.html?yrfaqsearch=cis%platin. Retrieved on 4/15/22.
3. Baude J, Cooper JS. Hyperbaric Contraindicated Chemotherapeutic Agents. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 11, 2021.
4. Torp KD, Carraway MS, Ott MC, et al. Safe administration of hyperbaric oxygen after bleomycin: a case series of 15 patients. Undersea Hyperb Med. 2012;39(5):873-879.