title: Jaundice as a presenting manifestation of pediatric non-Hodgkin lymphoma: etiology, management, and outcome.
abstract: OBJECTIVE
  There are few data available on the management and outcome of pediatric patients with non-Hodgkin lymphoma (NHL) presenting with jaundice. Controversies exist on biliary drainage and chemotherapy dose modifications to be carried out in such patients. The aim of this study was to analyze the causes of jaundice in, the various modalities of treatment administered to, and outcome of patients aged 18 years or less, with de novo NHL and jaundice treated at our center.
  
  
  METHODS
  A retrospective analysis show 9 such cases (11.2% of all NHL cases), all of whom were treated by a uniform protocol. Chemotherapy dose modifications were based on serum bilirubin and clinical status of the patients.
  
  
  RESULTS
  Obstructive jaundice was the most common cause (7 of 9). Seven patients achieved normal serum bilirubin with chemotherapy alone. Only one had a biliary drainage procedure. Four patients were alive and disease-free at last follow-up.
  
  
  CONCLUSIONS
  Although biliary obstruction is the commonest most cause of jaundice in pediatric and adolescent NHL, biliary drainage may be unnecessary and chemotherapy alone may suffice as initial treatment for these patients.
authors.affiliation: Department of Medical Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Indranil
authors.initials: I
authors.lastname: Ghosh
authors.forename: Sameer
authors.initials: S
authors.lastname: Bakhshi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004322:Drainage; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000473:pathology / Q000628:therapy; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome