Abstract
The hepatocytolysis raises questions on following therapeutic conduct when it occurs during chemotherapy for Hodgkin's lymphoma, expression of its liver toxicity. But the onset of primary liver Hodgkin's lymphoma, including the form manifested by acute liver failure, poses even greater problems, as in the case of occurrence of vanishing bile duct syndrome - expression of a paraneoplastic syndrome, hemophagocytic lymphohistiocytosis, peliosis hepatis or association of lymphoma with infection with hepatitis viruses or human immunodeficiency virus or different autoimmune diseases. This review summarizes the clinical experience acquired on the relationship between Hodgkin's lymphoma and liver, from the point of view of clinical manifestations, used treatments and clinical evolution. Suggestions on the course of treatment in patients with Hodgkin's lymphoma and liver damage have been formulated starting from the metabolism and elimination of chemotherapy drugs and taking into account the clinical experience of published clinical trials and cases. This review is a synthesis of knowledge obtained in this field, during the time, of therapeutic possibilities and limits, and formulates potential future milestones for research.
Highlights
Around 66,000 peoples were newly diagnosed with Hodgkin's lymphoma (HL) worldwide, and around 17,600 in Europe in 2012 [1,2]
Serum alkaline phosphatase and alanine aminotransferase (ALT) are two parameters that can make the best prediction on treatment response of HL, which stresses the importance of liver damage in this type of lymphoma
ABVD regimen: As doxorubicin is predominantly eliminated in the bile, liver function may be damaged in patients who have hepatic insufficiency or cholestasis
Summary
Around 66,000 peoples were newly diagnosed with Hodgkin's lymphoma (HL) worldwide, and around 17,600 in Europe in 2012 [1,2]. Serum alkaline phosphatase and alanine aminotransferase (ALT) are two parameters that can make the best prediction on treatment response of HL (according to the results of a study which investigated 35 clinical and biological parameters at the time of HL diagnosis, prior any therapy), which stresses the importance of liver damage in this type of lymphoma. These three variables suggest a pathogenic relationship between inflammation, iron overload (which has liver toxicity), liver damage and disease extension size [11]. BEAM graft conditioning regimen which consists in carmustine, etoposide, cytarabine and melphalan had less liver toxicity compared to busulfan, etoposide and melphalan (BuEM), but after BuEM progression free survival and overall survival of patients with HL was marginally significantly improved [12]
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