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Bleomycin and your lungs during Hodgkin treatment | CION Cancer Clinics
Bleomycin, part of ABVD and BEACOPP chemotherapy, can inflame the lungs in a minority of people with Hodgkin lymphoma. Warning signs are a new dry cough, breathlessness or fever. Report them to your team the same day. Found early, the inflammation often settles once your team stops bleomycin, and the rest of treatment usually continues. This page explains the risks, the checks and what to ask. At CION Cancer Clinics, our haematology team plans myeloma and lymphoma care with you, discussed at a tumour board and explained in plain words.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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The short answer
Can bleomycin damage the lungs?
Yes. Bleomycin, the "B" in ABVD and BEACOPP chemotherapy for Hodgkin lymphoma, can inflame the lungs in a minority of people. Caught early, it usually settles once the drug is stopped by your team, which is why a new cough or breathlessness during treatment should always be reported.
What actually happens in the lung
The lungs break bleomycin down more slowly than most organs do. In some people the drug irritates the thin lining of the air sacs, where oxygen passes into the blood. That irritation is called pneumonitis, which simply means inflammation of the lung. If it carries on unchecked, it can leave scarring, called fibrosis, that makes the lungs stiffer.
When it tends to appear
Most problems show up during the months of treatment or soon after the last cycle. Occasionally they appear later. The risk builds with the total amount of bleomycin received, so it matters more in the later cycles than the first.
Why doctors still use it
Bleomycin is a useful part of Hodgkin treatment, and most people finish without any lung trouble. Modern plans also use the interim PET-CT scan to drop bleomycin early for many people, keeping the benefit while cutting the exposure.
This page cannot tell you whether your cough is caused by bleomycin. Infection is more common and also needs checking.
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When breathing trouble cannot wait
If you or your parent on bleomycin becomes breathless at rest, has lips turning blue, or cannot finish a sentence, go to the nearest emergency department now or call 108. Say they are on chemotherapy with bleomycin. A new dry cough, a fever or getting breathless on stairs should be reported to the treating team the same day. Do not wait for the next cycle.
Not sure whether this applies to you?
Ask an oncologistRisk factors
Who is more likely to get lung damage?
Anyone on bleomycin can be affected. These factors make it more likely, and your team weighs them before and during treatment.
Older age
The risk rises in people over about forty, and more steeply in older adults. Many teams leave bleomycin out entirely for older patients, or stop it after the first cycles once the scan looks good.
Younger people are not free of risk, so the same symptom checks apply to everyone.Weaker kidneys
Bleomycin leaves the body through the kidneys. If they work less well, the drug stays longer and builds up. Kidney blood tests are checked before each cycle.
Smoking and lung disease
Current smoking, past heavy smoking, asthma, old tuberculosis scarring or other lung conditions all leave less reserve.
Tell the team about
- Any past TB treatment
- Inhalers you use
- Beedi, cigarette or hookah use
Chest radiotherapy
Radiotherapy to the chest, before or after bleomycin, adds its own strain on the lungs. The two together are planned carefully, and the radiation field is kept as small as possible.
Also worth mentioning
- Work with dust, fumes or chemicals
- Recent chest infections
Monitoring
How do doctors check your lungs during treatment?
A baseline test
Before the first cycle, lung function tests measure how much air you move and how well oxygen passes into the blood. This gives a starting point to compare against later.
Questions at every visit
You will be asked about cough, breathlessness and fever before each cycle. The doctor listens to your chest. Answer honestly, even if a symptom seems small.
Repeat tests if needed
A drop in the oxygen transfer measure, or new symptoms, leads to a repeat test, a chest X-ray or a CT scan of the chest.
A team decision
If damage is suspected, the haematologist decides whether to stop bleomycin and continue the other drugs. That is a planned change, not a failure of treatment.
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If it happens
What happens if your lungs are affected?
The first step is almost always stopping bleomycin for good. The team then treats the inflammation, most often with steroid medicines, and rules out an infection at the same time.
Continuing Hodgkin treatment
Stopping bleomycin does not mean stopping treatment for the lymphoma. The remaining drugs usually carry on, often as AVD, which is ABVD without the bleomycin. Trials have shown this is a reasonable way to continue for many people. Your haematologist will explain whether it suits your stage and scan results.
Recovery
Mild inflammation often improves over weeks to months. Where scarring has formed, some breathlessness on exertion can remain. Breathing exercises and a gradual return to walking help many people rebuild stamina.
After treatment ends
A past course of bleomycin matters for any future operation. High concentrations of oxygen during an anaesthetic can irritate the lungs again. Tell every anaesthetist and surgeon you have had bleomycin, even years later, and keep your treatment summary with you.
Never start or stop a steroid on your own. The dose is reduced slowly by the team.Commonly believed
What do people often misunderstand about it?
"A cough is just a cold. We will mention it next time."
During bleomycin treatment, any new cough or breathlessness needs the team to know the same day. Early inflammation is easier to settle than scarring that has had weeks to form.
"If bleomycin is stopped, the lymphoma will come back."
For many people the other drugs carry on effectively without it. Your team decides based on your stage and scan response, and will not drop it without thinking through that balance.
"Steam, herbal kadha or home remedies will clear the lungs."
These do not treat drug-related lung inflammation, and some herbal products interact with chemotherapy. Tell the team before taking anything, and do not let a remedy delay a check.
"Once treatment ends, the lung risk is over."
The main risk is during treatment, but a history of bleomycin still matters for anaesthesia and for smoking. Stopping smoking protects the lungs for life.
On your report
What do the words on a lung test report mean?
- PFT
- Pulmonary function tests. You breathe into a machine that measures how much air your lungs hold and move.
- DLCO
- How well oxygen crosses from the lungs into the blood. A falling DLCO can be an early sign of bleomycin effect.
- Pneumonitis
- Inflammation of the lung tissue. It can be caused by a drug, radiation or infection.
- Fibrosis
- Scarring that makes lung tissue stiffer and less able to pass oxygen.
- Ground-glass change
- A hazy area on a CT scan. It is not specific to bleomycin and is read alongside symptoms.
Questions we are asked
Common questions about bleomycin and the lungs
How common is lung damage from bleomycin?
It affects a minority of people treated for Hodgkin lymphoma, and serious damage is uncommon. The chance is higher with older age, weaker kidneys, smoking and chest radiotherapy. Your haematologist can tell you how these factors apply to you, and whether a plan without bleomycin is an option.
Should I stop bleomycin if I start coughing?
No. Do not change or skip anything on your own. Call the treating team the same day and describe the cough, any fever and how far you can walk before getting breathless. They decide whether to test, pause or stop bleomycin, and whether the rest of the treatment continues.
Is it safe to use oxygen at home?
Only as prescribed. After bleomycin, high oxygen levels can irritate the lungs, so doctors aim for the lowest amount that keeps your oxygen level safe. Never use an oxygen cylinder or concentrator without a doctor setting the flow, and tell any emergency team about the bleomycin.
Can the lung damage be reversed?
Inflammation found early often improves after bleomycin is stopped and steroids are given. Scarring that has already formed tends to stay, although many people adapt and stay active. Regular walking and breathing exercises help, and your team will follow your lung tests over time.
Why was my father given AVD instead of ABVD?
Older adults have a higher risk of lung damage from bleomycin. For them, many teams leave it out from the start or after a clear interim scan. The decision protects his lungs and is based on his age, fitness and scan results. Ask his team to walk you through it.
Does smoking make it worse?
Yes. Smoking adds its own damage and leaves the lungs less able to cope with inflammation. Stopping during treatment helps, and it is never too late. Ask the team for support to quit, as nicotine replacement can make it easier.
Will I need lung tests after treatment ends?
If you had symptoms or changes in your lung tests during treatment, the team will usually repeat them later. If not, routine follow-up focuses on how you feel. Report any breathlessness that develops after treatment, as it still deserves a check.
Can I do yoga or pranayama during treatment?
Gentle yoga and slow breathing practice are fine for most people and can ease anxiety. Avoid forceful or breath-holding exercises if you feel breathless, and stop if you become short of breath. Tell the team about any change in how easily you breathe.
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Sources
- Macmillan Cancer Support — Bleomycin
- National Cancer Institute — Adult Hodgkin Lymphoma Treatment (PDQ) - Patient Version
- Cancer Research UK — Hodgkin lymphoma
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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