Primary chemotherapy for obstructive jaundice caused by intermediate-grade non-Hodgkin lymphoma

Advanced non-Hodgkin lymphoma (NHL) usually is treated with doxorubicin-based combination chemotherapy. Because doxorubicin is excreted by the biliary route, many authorities recommend alternative initial interventions in patients with NHL causing obstructive jaundice.

The authors retrospectively reviewed the records of patients at Rochester General Hospital with NHL between 1983 and 1989 with obstructive jaundice at initial diagnosis.

Five patients with obstructive jaundice due to intermediate-grade NHL were treated with combination chemotherapy without prior surgical or endoscopic biliary decompression, or radiation therapy. Three received higher doses of doxorubicin than called for in standard dose modification tables. Jaundice was relieved rapidly in all five patients without unexpected toxic effects, and all five patients entered remission (three had partial remission and two complete remission).

Because biliary obstruction resolves rapidly after administration of chemotherapy for this disease, it is possible that standard dose reductions for doxorubicin and vincristine that are appropriate for patients with hepatocellular disease may be excessive for patients with obstructive jaundice resulting from lymphoma. The results of this study indicate that combination chemotherapy is appropriate initial therapy for patients with newly diagnosed NHL with obstructive jaundice.