Therapeutic Options in Patients With Lymphoma and Severe Liver Dysfunction

Ghobrial, Irene M.; Wolf, Robert C.; Pereira, Denise L.; Fonseca, Rafael; White, William L.; Colgan, Joseph P.; Habermann, Thomas M.; Inwards, David J.; Markovic, Svetomir N.; Ansell, Stephen M.; Micallef, Ivana N.M.; Porrata, Luis F.; Witzig, Thomas E.
February 2004
Mayo Clinic Proceedings;Feb2004, Vol. 79 Issue 2, p169
Academic Journal
• Objectives: To determine the long-term outcome of patients presenting with synchronous lymphoma and severe liver dysfunction and to describe the outcome of patients treated with initial mechlorethamine-based therapy used as a bridge to more conventional chemotherapy. • Patients and Methods: We reviewed the clinical course of all patients diagnosed as having lymphoma who presented with severe liver dysfunction and received intravenous mechlorethamine between September 1988 and February 2003 at the Mayo Clinic in Rochester, Minn. • Results: Forty-one patients were identified, 33 (80%) of whom had newly diagnosed, previously untreated lymphoma. Thirty-seven (90%) had non-Hodgkin lymphoma, and 4 (10%) had Hodgkin disease. Thirty-four patients (83%) had stage IV disease, and 31 (84%) of 37 had an intermediate-high International Prognostic Index. The median total bilirubin level before therapy was 10.7 mg/dL (range, 2.5-30.2 mg/dL), and the median alkaline phosphatase level was 982 U/L (range, 233-3415 U/L). In addition to mechlorethamine, 34 patients (83%) received concomitant corticosteroids, and 12 (29%) received concomitant rituximab. Twenty-two patients (54%) had sufficient improvement in liver function to receive subsequent standard chemotherapy. Nine patients (22%) are alive and disease-free at a median of 31 months (range, 4 to ≥87 months) after mechlorethamine treatment. Factors associated with improved overall survival included improvement in bilirubin levels (P<.001) and receiving subsequent standard chemotherapy (P=.001). • Conclusion: Mechlorethamine, high-dose corticosteroids, and rituximab are useful therapeutic interventions for this unique group of patients with lymphoma and severe liver dysfunction. Substantial clinical improvement and long-term survival are possible. AST = aspartate aminotransferase; CHOP = cyclophosphamide, hydroxydaunomycin (doxorubicin), Oncovin (vincristine), and prednisone; CT = computed tomography; HD = Hodgkin disease; IPI = International Prognostic Index; LDH = lactate dehydrogenase; NHL = non-Hodgkin lymphoma.


Related Articles

  • Successful lamivudine therapy for post-chemotherapeutic fulminant hepatitis B in a hepatitis B virus carrier with non-Hodgkin's lymphoma: case report and review of the literature. Kawai, Y.; Ikegaya, S.; Hata, M.; Kawahito, M.; Imamura, S.; Yoshida, A.; Tsutani, H.; Ueda, T. // Annals of Hematology;Aug2001, Vol. 80 Issue 8, p482 

    Reactivation of hepatitis B virus (HBV), especially after withdrawal of corticosteroids is a well-known complication during chemotherapy for lymphoma. The high mortality makes this complication one of the major obstacles to completing the standard treatment for lymphoma in HBV carriers. We...

  • Cyclophosphamide/doxorubicin/rituximab.  // Reactions Weekly;1/20/2007, Issue 1135, p14 

    The article presents a case study of a 57-year-old man who developed a hepatitis g virus (HBV) reactivation secondary to a YMDD mutation after chemotherapy with cyclophosphamide, doxorubicin and rituximab for follicular lymphoma. After a series of chemotherapy with the said drugs, the patient...

  • Novel applications of Rituximab in dermatological disorders. Bhandari, Prasan R.; Pai, Varadraj V. // Indian Dermatology Online Journal;Jul-Sep2014, Vol. 5 Issue 3, p250 

    Rituximab is a monoclonal therapeutic anti-CD20 antibody that has been approved for use in lymphoma and rheumatoid arthritis. Over the past decade several reports based on case series and observational studies have recorded the benefits of rituximab in particular groups of dermatological...

  • Survey shows that many asthma patients are misinformed about their medications.  // Modern Medicine;Jun98, Vol. 66 Issue 6, p14 

    Presents an abstract of the article `Perception of the Role and Potential Side Effects of Inhaled Corticosteroids Among Asthmatic Patients,' from the journal `Chest' dated March 1998.

  • First-line Combination Therapy with Rituximab and Corticosteroids is Effective and Safe for Pemphigus. Yung-Tsu Cho; Fang-Yu Lee; Chia-Yu Chu; Li-Fang Wang // Acta Dermato-Venereologica;Jul2014, Vol. 94 Issue 4, p472 

    The article describes case studies regarding the successful use of rituximab and corticosteroids as first-line combination therapy for the autoimmune disease pemphigus. Topics discussed include acceptable side effects of rituximab, morbidities and mortalities associated with long-term use of...

  • Rituximab.  // Reactions Weekly;9/1/2007, Issue 1167, p23 

    The article presents a case report of a 63-year-old woman who, during rituximab-based chemotherapy for low-grade non-Hodgkin's lymphoma (NHL), developed progressive multifocal leukoencephalopathy (PML). The woman, after being diagnosed with NHL, started treatment with rituximab,...

  • Primary CNS lymphoma in immunocompetent patients from 1989 to 2001: a retrospective analysis of 164 cases uniformly diagnosed by stereotactic biopsy. Feuerhake, F.; Baumer, C.; Cyron, D.; Illerhaus, G.; Olschewski, M.; Tilgner, J.; Ostertag, C. B.; Volk, B. // Acta Neurochirurgica;Aug2006, Vol. 148 Issue 8, p831 

    Background. We present outcome data of a cohort of 164 immunocompetent PCNSL patients uniformly diagnosed at a single center for stereotactic neurosurgery, and evaluate the acceptance and impact of combination radiotherapy (RT) and chemotherapy (CHT) with high-dose methotrexate (HD-MTX) over...

  • R-BAC shows promise in mantle cell lymphoma.  // Hem/Onc Today;4/25/2013, Vol. 14 Issue 8, p15 

    The article discusses the results of a study which showed that a therapy combining cytarabine, bendamustine and rituximab is linked to strong response-related outcomes in mantle cell lymphoma.

  • Rituximab.  // Reactions Weekly;9/2/2006, Issue 1117, p20 

    The article discusses research on the use of rituximab in the chemotherapy of three men with non-Hodgkin's lymphoma (NHL). These men developed decrease heart function during chemotherapy. They all received a drip infusion of IV rituximab 375 milligrams. His NHL caused the 80-year-old man's...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics