Intralesional bleomycin injection for lymphaticand venous malformations

What is Bleomycin?

Bleomycin is a medicine that has been used for many years in the treatment of other illnesses.

So why am I being offered Bleomycin?

We have suggested bleomycin as a treatment for your malformation for one or more of the following reasons:

• The type of lesion has been shown to respond best to bleomycin
• The lesion is in an area where we would be keen to avoid excessive swelling as a result of treatment e.g. near the eye
• If your previous injections into the lesion have failed to improve your symptoms
• If your lesion is close to the skin surface.

Is Bleomycin safe?

Bleomycin is a medicine that has been used for many years to treat other conditions, such as cancer.

In a few cases, when it has been used in much higher doses than we would use for sclerotherapy, for example in cancer treatment, and where bleomycin has been injected straight into the bloodstream, it can cause damage and changes to the lungs and how they function. This can happen during treatment or afterwards.

In bleomycin sclerotherapy doses are much lower and the medicine is not given in the same way; not directly into the bloodstream, so the risk is much lower; however, there have been cases reported of lung issues post-bleomycin sclerotherapy.

Extra oxygen may also increase the risk of lung problems during and after treatment with bleomycin. Lung problems can occur months or years after treatment.

With this in mind it is import to make sure you:

1. Inform your doctors or dentists that you have been treated with bleomycin before you receive any type of surgery.
2. Carry a wallet card (we will provide these) or wear a wrist bracelet (e.g., MEDICALERT®) to alert health providers.

We suggest avoiding activities or occupations which use increased oxygen pressure, such as scuba diving, for the rest of your life. You should also avoid smoking or vaping.

You should also let them know if any existing breathing problems get worse. If necessary, your doctor can arrange for you to have tests to check your lungs.

Very rarely, bleomycin can cause some discolouration of the skin or nails or make some hair fall out. This usually gets better with time.

We think that the skin is more likely to be affected if there are monitoring leads or plasters stuck to the skin at the time of treatment or if you scratch your skin after treatment. Therefore we will be very careful to put sticky plasters or leads onto parts of the skin that are not noticeable and we may well prescribe you some anti-allergy tablets (antihistamine).

Assessments carried out before Bleomycin sclerotherapy

You will meet a radiology doctor (Interventional Radiologist) in clinic who will explain the procedure in more detail and discuss any questions you may have. You will be asked to sign a consent form; we will talk you through the process so you understand what you are consenting to before giving your permission for you to have sclerotherapy.

It is important that you know you do not have to make a decision straight away. The reason we see you in clinic and give you patient information sheets, such as these, is so you can make a well-thought-out decision regarding your treatment. If you would like more time to think then please let the doctors know. There is a section at the end of this information sheet for any thoughts or questions you may have after your meeting with the Interventional Radiologist.

You will need a pre-admission assessment to check that you are well enough for the procedure and to confirm that your lungs are healthy. If you have any medical problems, please tell the nurses and doctors. You may well see an anaesthetist at the same time who will talk to you about your anaesthetic. This appointment may be booked for several weeks before sclerotherapy or for the day before the procedure.

As bleomycin could harm an unborn baby, we will ask all women about their periods and any chance that they could be pregnant. We will also ask for a urine sample to carry out a pregnancy test.

Follow-up carried out after Bleomycin sclerotherapy

We will send a letter to your GP so they are aware of the procedure you have had.
We will also provide you with an alert card advising any medical professional that you have had intralesional bleomycin.

We will contact you by phone at one, four and eight weeks following your treatment where we will assess for expected side effects and to assess to see if you have a dry cough that hasn’t resolved and / or are short of breath.

We will also review you at an outpatient clinic appointment at three months.

Contact details

Please contact us on the numbers below if you develop any side effects, such as a continuing dry cough, wheezing, chest pain, fever or shortness of breath.