Therapeutic options for patients with lymphoma and liver dysfunction or failure during mechlorethamine shortage

Liver dysfunction in patients with lymphoma presents an important clinical dilemma because it limits the use of anthracyclines and vinca alkaloids for this potentially curable malignancy. Patients are typically treated with corticosteroids, rituximab and the nitrogen mustard mechlorethamine, and then transitioned to definitive therapy after improvement in liver function. Between 2010 and 2012 mechlorethamine was not available and other strategies were required. In this case series, we describe seven cases of patients with lymphoma and liver dysfunction successfully treated in this time period with ifosfamide/carboplatin or gemcitabine/cisplatin.