NON-HODGKINS-LYMPHOMA PRESENTING WITH BILIARY-TRACT OBSTRUCTION - A DISCUSSION OF 7 PATIENTS AND A REVIEW OF THE LITERATURE

Background. Biliary tract obstruction is a rare manifestation of non-H odgkin's lymphoma (NHL). Because of the small numbers of patients stud ied, management of this condition has been inconsistent. Most patients have been treated with biliary diversion, and doxorubicin frequently has been withheld from initial therapy. Methods. Seven patients with N HL presenting with malignant biliary tract obstruction were identified at the Massachusetts General Hospital. Relevant clinical characterist ics, laboratory values, treatment, and outcome are reported for ail pa tients. Thirty-eight additional patients were identified through a MED LINE search; and the management and results of the patients reported h ere are discussed with reference to those patients. Results. Biliary t ract obstruction was the presenting symptom in 0.8% of the patients wi th NHL. Bilirubin values at presentation ranged from 5.0-23.2 mg/dl. O ne patient had localized pancreatic lymphoma. Four of the seven patien ts had advanced-stage disease. The tumor was intermediate or high grad e in five patients. Four patients underwent placement of a biliary ste nt or drainage catheter, Six patients received combination chemotherap y without doxorubicin in the initial cycle. Hyperbilirubinemia resolve d in all patients within 3 months, regardless of use of a stent. Six p atients responded to chemotherapy and one patient had progressive dise ase. Two of the six responders died, one with relapsed lymphoma. Concl usions. NHL presenting with biliary tract obstruction can be effective ly treated with chemotherapy, with or without a procedure for biliary diversion. The use of doxorubicin in the presence of hyperbilirubinemi a secondary to biliary tract obstruction remains controversial, and it s omission from the initial cycles of chemotherapy for NHL may not inf luence outcome.