Anthracycline-based chemotherapy is the cornerstone of modern curative regimens 
for aggressive lymphomas; however, these drugs cannot be safely administered in 
the setting of severe hepatic dysfunction. Alternative regimens for this setting 
are required. We describe 2 patients with newly diagnosed advanced aggressive 
lymphoma (diffuse large B-cell lymphoma [DLBCL] and classic Hodgkin lymphoma 
[HL]) presenting with severe hepatic dysfunction with hyperbilirubinemia 
(4.3-13.2 mg/dL). Because of the inability to safely administer unattenuated 
doses of anthracycline-based regimens, dexamethasone, high-dose cytarabine, and 
cisplatin (DHAP) was used at full doses (along with rituximab for the DLBCL 
patient) until hepatic function normalized (1-5 cycles). The treatment was then 
converted to R-CHOP (rituximab/cyclophosphamide/ 
doxorubicin/vincristine/prednisone) and ABVD 
(doxorubicin/bleomycin/vinblastine/dacarbazine) for the DLBCL and HL patient, 
respectively, to complete therapy. The patients had a partial remission and 
complete remission, respectively. These data suggest that DHAP is a safe and 
effective regimen that can be used without dose modification as part of initial 
therapy in the setting of aggressive lymphoma and hepatic failure. The 
literature on the use of treatment regimens for aggressive lymphoma in the 
setting of hepatic dysfunction is reviewed.