Therapeutic Options in Patients with Lymphoma and Severe Liver Dysfunction

Irene M. Ghobrial, Robert C. Wolf, Denise L. Pereira, Rafael Fonseca, William L. White, Joseph P. Colgan, Thomas Matthew Habermann, David J. Inwards, Svetomir Nenad Markovic, Stephen Maxted Ansell, Ivana Micallef, Luis F. Porrata, Thomas Elmer Witzig

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)169-175
Number of pages7
JournalMayo Clinic Proceedings
Volume79
Issue number2
StatePublished - 2004

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Liver Diseases
Lymphoma
Mechlorethamine
Therapeutics
Bilirubin
Drug Therapy
Adrenal Cortex Hormones
Survival
Hodgkin Disease
Non-Hodgkin's Lymphoma
Alkaline Phosphatase
Liver

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Ghobrial, I. M., Wolf, R. C., Pereira, D. L., Fonseca, R., White, W. L., Colgan, J. P., ... Witzig, T. E. (2004). Therapeutic Options in Patients with Lymphoma and Severe Liver Dysfunction. Mayo Clinic Proceedings, 79(2), 169-175.

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 Matthew; Inwards, David J.; Markovic, Svetomir Nenad; Ansell, Stephen Maxted; Micallef, Ivana; Porrata, Luis F.; Witzig, Thomas Elmer.

In: Mayo Clinic Proceedings, Vol. 79, No. 2, 2004, p. 169-175.

Research output: Contribution to journalArticle

Ghobrial, IM, Wolf, RC, Pereira, DL, Fonseca, R, White, WL, Colgan, JP, Habermann, TM, Inwards, DJ, Markovic, SN, Ansell, SM, Micallef, I, Porrata, LF & Witzig, TE 2004, 'Therapeutic Options in Patients with Lymphoma and Severe Liver Dysfunction', Mayo Clinic Proceedings, vol. 79, no. 2, pp. 169-175.
Ghobrial IM, Wolf RC, Pereira DL, Fonseca R, White WL, Colgan JP et al. Therapeutic Options in Patients with Lymphoma and Severe Liver Dysfunction. Mayo Clinic Proceedings. 2004;79(2):169-175.
Ghobrial, Irene M. ; Wolf, Robert C. ; Pereira, Denise L. ; Fonseca, Rafael ; White, William L. ; Colgan, Joseph P. ; Habermann, Thomas Matthew ; Inwards, David J. ; Markovic, Svetomir Nenad ; Ansell, Stephen Maxted ; Micallef, Ivana ; Porrata, Luis F. ; Witzig, Thomas Elmer. / Therapeutic Options in Patients with Lymphoma and Severe Liver Dysfunction. In: Mayo Clinic Proceedings. 2004 ; Vol. 79, No. 2. pp. 169-175.
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abstract = "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.",
author = "Ghobrial, {Irene M.} and Wolf, {Robert C.} and Pereira, {Denise L.} and Rafael Fonseca and White, {William L.} and Colgan, {Joseph P.} and Habermann, {Thomas Matthew} and Inwards, {David J.} and Markovic, {Svetomir Nenad} and Ansell, {Stephen Maxted} and Ivana Micallef and Porrata, {Luis F.} and Witzig, {Thomas Elmer}",
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AU - Ghobrial, Irene M.

AU - Wolf, Robert C.

AU - Pereira, Denise L.

AU - Fonseca, Rafael

AU - White, William L.

AU - Colgan, Joseph P.

AU - Habermann, Thomas Matthew

AU - Inwards, David J.

AU - Markovic, Svetomir Nenad

AU - Ansell, Stephen Maxted

AU - Micallef, Ivana

AU - Porrata, Luis F.

AU - Witzig, Thomas Elmer

PY - 2004

Y1 - 2004

N2 - 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.

AB - 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.

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