Hodgkin Lymphoma With Liver Involvement (Diagnostic, Therapeutic Difficulties, and Literature Review): A Retrospective Cohort Study

Abstract

Background and Aims: In classical Hodgkin lymphoma liver involvement occurs in 5%–8%, ranging from mild dysfunction to acute liver failure. Recognition and treatment of advanced cases are challenging due to rapid progression and limited use of therapies. Methods: We analyzed the data of 250 Hodgkin lymphoma patients; 9 had liver involvement, one in the form of acute liver failure. Results: Laboratory findings showed elevations of cholestatic enzymes, lactate dehydrogenase and haemostatic changes. PET/CT showed solo or multiple active areas in the liver and diffuse elevated standard uptake value in the patient with acute liver failure. In six cases ABVD/EBVD, in two brentuximab vedotin+AVD were used. Four patients achieved complete remission, four were relapsed or refractory, three of them died later. Brentuximab vedotin was started for the patient with acute liver failure, but she died in 2 days. Autopsy confirmed a Hodgkin-infiltrated liver structure. Conclusion: Liver involvement has a negative impact on prognosis; however, early diagnosis and immediate initiation of therapy improve liver function. PET/CT can be a practical tool to support diagnosis and monitor response to therapy in patients where liver biopsy is not possible or does not contribute significantly to clinical management. With preserved liver function, ABVD is an effective treatment option, while with worsening liver function, brentuximab vedotin can be a safe alternative.