PRIMARY CHEMOTHERAPY FOR OBSTRUCTIVE-JAUNDICE CAUSED BY INTERMEDIATE-GRADE NON-HODGKIN LYMPHOMA

Background. Advanced non-Hodgkin lymphoma (NHL) usually is treated wit h doxorubicin-based combination chemotherapy. Because doxorubicin is e xcreted by the biliary route, many authorities recommend alternative i nitial interventions in patients with NHL causing obstructive jaundice . Methods. The authors retrospectively reviewed the records of patient s at Rochester General Hospital with NHL between 1983 and 1989 with ob structive jaundice at initial diagnosis. Results. Five patients with o bstructive jaundice due to intermediate-grade NHL were treated with co mbination chemotherapy without prior surgical or endoscopic biliary de compression, or radiation therapy. Three received higher doses of doxo rubicin than called for in standard dose modification tables. jaundice was relieved rapidly in all five patients without unexpected toxic ef fects, and all five patients entered remission (three had partial remi ssion and two complete remission). Conclusions. Because biliary obstru ction resolves rapidly after administration of chemotherapy for this d isease, it is possible that standard dose reductions for doxorubicin a nd vincristine that are appropriate for patients with hepatocellular d isease may be excessive for patients with obstructive jaundice resulti ng from lymphoma. The results of this study indicate that combination chemotherapy is appropriate initial therapy for patients with newly di agnosed NHL with obstructive jaundice.