Comparative review of hepatic and renal toxicities in Hodgkin and non-Hodgkin lymphoma chemotherapy

Abstract

Objective: This review aimed to comparatively analyse the existing literature on the impact of standard chemotherapy regimens on hepatic and renal function parameters in patients with Hodgkin Lymphoma (HL) versus Non-Hodgkin Lymphoma (NHL).

Methods: A comprehensive literature search was conducted across PubMed, ScienceDirect, and Google Scholar from inception to March 2024. The review included original research, reviews, meta-analyses, and case reports published in English that focused on hepatic and/or renal function in adult HL or NHL patients receiving standard chemotherapy. Studies solely on paediatric populations, those focusing on other toxicities without a significant hepatic/renal focus, and non-peer-reviewed works were excluded. Data on regimens, organ function abnormalities, toxicity incidence, risk factors, and mechanisms were synthesised.

Results: The analysis revealed distinct toxicity profiles. HL regimens (ABVD, BEACOPP) are associated with direct, though often transient, hepatotoxicity and a lower risk of renal impairment. In contrast, NHL regimens (R-CHOP, R-CVP, BR) carry a significant risk of Hepatitis B Virus reactivation, leading to severe hepatotoxicity. Furthermore, aggressive NHL subtypes are highly susceptible to acute kidney injury driven by Tumour Lysis Syndrome. Key risk modifiers include baseline viral status, pre-existing organ dysfunction, and cumulative drug doses.

Conclusion: The patterns of chemotherapy-induced hepatic and renal toxicity differ markedly between HL and NHL. Recognising these differences is crucial for implementing tailored prophylactic strategies, vigilant monitoring, and timely interventions to mitigate adverse outcomes and improve patient safety and quality of life.