Cancer survivor with history of bleomycin exposure — most commonly testicular germ-cell t...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-IATROGENIC-BLEOMYCIN-LATE-PREVENTION`
Type	Red flag
Status	reviewed 2026-05-18 \| pending_clinical_signoff
Diseases	`DIS-NSCLC`
Sources	`SRC-COG` `SRC-NCCN-BCELL-2025` `SRC-NCCN-NSCLC-2025`

Red Flag Origin

Definition	Cancer survivor with history of bleomycin exposure — most commonly testicular germ-cell tumor BEP/EP cycles, Hodgkin lymphoma ABVD or escalated BEACOPP, head-and-neck SCC platinum-bleomycin (legacy). Three pulmonary domains: (1) bleomycin-induced pulmonary fibrosis — dose- dependent (incidence ~10% at cumulative 270-360 units, higher with oxygen exposure, renal dysfunction); subclinical DLCO decline common long-term even at lower cumulative doses; (2) accelerated lung-cancer risk in smokers — bleomycin + tobacco DNA-damage synergy increases second-primary lung-cancer risk; (3) susceptibility to high-FiO2 oxygen-induced lung toxicity lifelong (relevant for any future surgery / scuba diving / hyperbaric exposure). Surveillance focus on pulmonary function tests (FEV1, FVC, DLCO) with chest exam at routine survivorship visits; LDCT lung-cancer screening eligibility shifts toward inclusion f...
Clinical direction	investigate
Category	other

Trigger Logic

{
  "any_of": [
    {
      "finding": "survivor_prior_bleomycin_exposure",
      "value": true
    },
    {
      "finding": "survivor_bleomycin_plus_smoking_history",
      "value": true
    },
    {
      "finding": "survivor_bep_or_abvd_history_pulmonary_late_effect",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Cancer-survivor late-effects RedFlag for prior bleomycin exposure. Surveillance domains: pulmonary fibrosis (PFTs + chest exam), second-primary lung cancer (LDCT eligibility shift if smoking history — bleomycin + tobacco synergistic), lifelong high-FiO2 oxygen-toxicity caution. STUB pending two-Clinical-Co-Lead signoff per CHARTER §6.1 dev-mode.

Used By

Indications

IND-IATROGENIC-BLEOMYCIN-LATE-PREVENTION-OBSERVATION - IND-IATROGENIC-BLEOMYCIN-LATE-PREVENTION-OBSERVATION
IND-IATROGENIC-BLEOMYCIN-LATE-PREVENTION-SURVEILLANCE - IND-IATROGENIC-BLEOMYCIN-LATE-PREVENTION-SURVEILLANCE