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Fatima I, Mahadevia H, Madhusudhana S, Shrestha A. Vanishing bile duct syndrome as a presentation of Hodgkin's lymphoma. BMJ Case Rep 2024; 17:e256818. [PMID: 38772873 DOI: 10.1136/bcr-2023-256818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024] Open
Abstract
Vanishing bile duct syndrome is an uncommon condition characterised by the progressive loss and disappearance of bile ducts. It is an acquired form of cholestatic liver disease presenting with hepatic ductopenia (loss of >50% bile ducts in the portal areas). We present a case of vanishing bile duct syndrome as a presentation of Hodgkin's lymphoma who was treated with standard-of-care chemotherapy-doxorubicin, bleomycin, vinblastine and dacarbazine (along with brief administration of rituximab), which led to complete response and normalisation of liver function.
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Affiliation(s)
- Ifrah Fatima
- Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Himil Mahadevia
- Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Sheshadri Madhusudhana
- Medicine, Section of Hematology and Oncology, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Anuj Shrestha
- Medicine, Section of Hematology and Oncology, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
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2
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Wang Y, Wang Z, Wei C, Zhao D, Zhang Y, Wang W, Zhang W, Zhou D. Single-agent brentuximab vedotin as frontline therapy for Hodgkin lymphoma patients with severe hepatic impairment: a report of two cases. Ann Hematol 2023; 102:2973-2975. [PMID: 37522969 DOI: 10.1007/s00277-023-05390-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Yupeng Wang
- School of Medicine, Tsinghua University, Beijing, China
| | - Zi Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Chong Wei
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Danqing Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Yan Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Wei Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China.
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, 100005, China
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Cook M, Williams M, Law JY, Riedel DJ. Fulminant Hepatic Failure as the Initial Presentation of Hodgkin Lymphoma in 4 Patients With Human Immunodeficiency Virus. Open Forum Infect Dis 2023; 10:ofad273. [PMID: 37404950 PMCID: PMC10316689 DOI: 10.1093/ofid/ofad273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Indexed: 07/06/2023] Open
Abstract
In the era of antiretroviral therapy (ART), Hodgkin Lymphoma (HL) is a common non-AIDS-defining cancer with increasing incidence in people with human immunodeficiency virus (PWH). Through review of these cases, we identify clinical patterns such as declining CD4 count despite ART, hyperbilirubinemia and recurrent fever, which preceded diagnosis. Identifying these important signs and symptoms may lead to earlier diagnosis and initiation of therapy. Fulminant hepatic failure limits the ability to give standard of care chemotherapy, likely jeopardizing outcomes in this patient population. Alternative bridging therapies should be considered until hepatic function improves.
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Affiliation(s)
- Mary Cook
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Matthew Williams
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Jennie Y Law
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David J Riedel
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
- Division of Infectious Disease, University of Maryland Medical Center, Baltimore, Maryland, USA
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Ishitsuka K, Yokoyama Y, Baba N, Matsuoka R, Sakamoto N, Sakamoto T, Kusakabe M, Kato T, Kurita N, Nishikii H, Sakata-Yanagimoto M, Obara N, Hasegawa Y, Chiba S. Administration of brentuximab vedotin to a Hodgkin lymphoma patient with liver dysfunction due to vanishing bile duct syndrome resulting in a partial response without any severe adverse events. J Clin Exp Hematop 2022; 62:154-157. [PMID: 35831099 PMCID: PMC9635035 DOI: 10.3960/jslrt.21035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Vanishing bile duct syndrome (VBDS) is a rare hepatic disorder which leads to liver failure as a result of progressive destruction of the intrahepatic bile ducts. There are no treatment modalities for VBDS itself and severe hepatic dysfunction restricts the treatment of underlying diseases. We safely treated a case of classic Hodgkin lymphoma (HL) with VBDS using brentuximab vedotin (BV). The patient was treated with 5 cycles of reduced BV and a partial metabolic response was obtained. Moreover, a standard dose of BV for another 5 cycles was accomplished with minimal adverse events. Our experience indicates that BV could be a treatment option for classic HL with VBDS.
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Affiliation(s)
- Kantaro Ishitsuka
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yasuhisa Yokoyama
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan.,Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naoko Baba
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Ryota Matsuoka
- Department of Diagnostic Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Noriaki Sakamoto
- Department of Diagnostic Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tatsuhiro Sakamoto
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan.,Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Manabu Kusakabe
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan.,Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takayasu Kato
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan.,Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naoki Kurita
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan.,Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hidekazu Nishikii
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan.,Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mamiko Sakata-Yanagimoto
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan.,Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naoshi Obara
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan.,Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuichi Hasegawa
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan.,Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shigeru Chiba
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan.,Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Veeraballi S, Chan KH, Slim J, Shaaban HS, Guron G. A successful initiation of treatment of Hodgkin's lymphoma with adriamycin-bleomycin-vinblastine-dacarbazine dose reduction in a patient with fulminant hepatic failure and co-infection with human immunodeficiency virus and hepatitis B. J Oncol Pharm Pract 2021; 28:479-485. [PMID: 34590528 DOI: 10.1177/10781552211040182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Hodgkin lymphoma is a highly curable lymphoproliferative malignancy with an overall relative survival rate of 87.4%. It is characterized by multinucleated Reed-Sternberg cells which are mostly derived from B cells in the germinal center. CASE REPORT We present a case of a 40-year-old gentleman with acquired immunodeficiency syndrome who presented with Stage 4b Hodgkin lymphoma complicated with fulminant hepatic failure and direct hyperbilirubinemia. The initial presentation of Hodgkin lymphoma as cholestatic jaundice is extremely rare. MANAGEMENT AND OUTCOME Though the survival rate with chemotherapy is high, the fulminant hepatic failure made the situation challenging with the use of chemotherapeutic regimens that require hepatic excretion. He received dose reduced adriamycin-bleomycin-vinblastine-dacarbazine regimen [doxorubicin 12.5 mg (6.75 mg/m2), bleomycin 18 units (10 units/m2), vinblastine 3 mg (1.5 mg/m2), dacarbazine 380 mg (190 mg/m2)] as well as bictegravir/emtricitabine/tenofovir alafenamide since admission for treatment of human immunodeficiency virus and hepatitis B. He started responding with the first cycle of dose reduced adriamycin-bleomycin-vinblastine-dacarbazine regimen with bilirubin levels trended down and normalized as well as his clinical condition improved. He received the full dose of adriamycin-bleomycin-vinblastine-dacarbazine on day 15. DISCUSSION Our case report emphasizes that the early usage of dose reduced adriamycin-bleomycin-vinblastine-dacarbazine regimen can restore hepatic function and can achieve improvement in hepatic function allowing the delivery of full-dose chemotherapy.
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Affiliation(s)
- Sindhusha Veeraballi
- Department of Medical Education, 22423Saint Michael's Medical Center, New York Medical College, USA
| | - Kok H Chan
- Department of Medical Education, 22423Saint Michael's Medical Center, New York Medical College, USA
| | - Jihad Slim
- Department of Medical Education, 22423Saint Michael's Medical Center, New York Medical College, USA.,Department of Infectious Disease, 22423Saint Michael's Medical Center, New York Medical College, USA
| | - Hamid S Shaaban
- Department of Medical Education, 22423Saint Michael's Medical Center, New York Medical College, USA.,Department of Hematology/Oncology, 22423Saint Michael's Medical Center, New York Medical College, USA
| | - Gunwant Guron
- Department of Medical Education, 22423Saint Michael's Medical Center, New York Medical College, USA.,Department of Hematology/Oncology, 22423Saint Michael's Medical Center, New York Medical College, USA
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Vassilakopoulos TP, Asimakopoulos JV, Konstantopoulos K, Angelopoulou MK. Optimizing outcomes in relapsed/refractory Hodgkin lymphoma: a review of current and forthcoming therapeutic strategies. Ther Adv Hematol 2020; 11:2040620720902911. [PMID: 32110285 PMCID: PMC7026824 DOI: 10.1177/2040620720902911] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 12/18/2019] [Indexed: 12/21/2022] Open
Abstract
The outcome of patients with relapsed/refractory classical Hodgkin lymphoma (rr-cHL) has improved considerably in recent years owing to the approval of highly active novel agents such as brentuximab vedotin and Programmed Death-1 (PD-1) inhibitors. Although no randomized trials have been conducted to provide formal proof, it is almost undisputable that the survival of these patients has been prolonged. As autologous stem-cell transplantation (SCT) remains the standard of care for second-line therapy of most patients with rr-cHL, optimization of second-line regimens with the use of brentuximab vedotin, or, in the future, checkpoint inhibitors, is promising to increase both the eligibility rate for transplant and the final outcome. The need for subsequent therapy, and especially allogeneic SCT, can be reduced with brentuximab vedotin consolidation for 1 year, while pembrolizumab is also being tested in this setting. Several other drug categories appear to be active in rr-cHL, but their development has been delayed by the appearance of brentuximab vedotin, nivolumab and pembrolizumab, which have dominated the field of rr-cHL treatment in the last 5 years. Combinations of active drugs in chemo-free approaches may further increase efficacy and hopefully reduce toxicity in rr-cHL, but are still under development.
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., Goudi, Athens, 11527, Greece
| | - John V Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maria K Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Ding J, Kumar AJ, Wilding E, Lee ST, Law JY. Multi-Organ Failure as the Initial Presentation of Lymphocyte-Depleted Hodgkin Lymphoma in Two Patients with Human Immunodeficiency Virus. Acta Haematol 2019; 143:184-188. [PMID: 31597150 DOI: 10.1159/000500222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 04/08/2019] [Indexed: 01/12/2023]
Abstract
Patients with HIV-associated lymphocyte-depleted Hodgkin lymphoma (HIV-HL) often present with advanced, extranodal disease and aggressive clinical features, limiting definitive therapeutic intervention. Here we report two patients with HIV-HL who presented with multi-organ dysfunction as an initial manifestation of their malignancy. Both were initially treated with brentuximab vedotin (BV), which led only to a temporary partial response, highlighting the challenges of treatment. One patient was eventually started on nivolumab and responded very well to the immune checkpoint inhibitor. To our knowledge, this is the first case to describe successful use of nivolumab in a patient with relapsed lymphocyte-depleted HIV-HL. Prompt recognition of multi-organ dysfunction as an initial presentation of lymphocyte-depleted HIV-HL is essential to ensure rapid provision of therapy. While use of BV remains a reasonable option, earlier introduction of immunotherapy in the treatment of HL may provide an additional option in critically ill patients with lymphocyte-depleted HIV-HL.
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Affiliation(s)
- Jennifer Ding
- University of Maryland Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, Baltimore, Maryland, USA,
| | - Avnee J Kumar
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Emily Wilding
- Department of Pathology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Seung Tae Lee
- University of Maryland Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Jennie Y Law
- University of Maryland Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, Baltimore, Maryland, USA
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Mihăilă RG. Liver Involvement in Hodgkin's Lymphoma: Types of Injuries and Therapeutic Implications. ACTA ACUST UNITED AC 2017. [DOI: 10.18052/www.scipress.com/ijppe.8.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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.
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