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Cardiac non-Hodgkin's lymphoma: clinical characteristics and trends in survival
Max J Gordon1, Olga Danilova2, Stephen Spurgeon1,3
1Department of Internal Medicine, Oregon Health & Sciences University, Portland, OR, USA.
Insights
Cardiac non-Hodgkin's lymphoma (NHL) is often aggressive, with heart failure a common symptom. Chemotherapy significantly improves survival for cardiac NHL, especially B-cell types, offering hope for durable remissions.
Area of Science:
- Cardiology
- Oncology
- Hematology
Background:
- Cardiac involvement in non-Hodgkin's lymphoma (NHL) is rare but serious.
- Understanding clinical characteristics and outcomes is crucial for patient management.
Purpose of the Study:
- To describe the clinical features and outcomes of patients with cardiac non-Hodgkin's lymphoma (NHL).
Main Methods:
- Retrospective analysis of 94 cases of biopsy-proven cardiac NHL.
- Data collected from PubMed between 1990 and 2015.
Main Results:
- Diffuse large B-cell lymphoma was the most common subtype (58%).
- Heart failure was the most frequent presentation (34%); 20% were asymptomatic.
- Median survival was 3 months, but chemotherapy prolonged it to 18 months (P = 0.0003).
Conclusions:
- Cardiac NHL requires consideration in patient evaluation.
- Chemotherapy offers durable remissions, particularly for B-cell NHL with cardiac involvement.
Objectives:
The purpose of this study was to describe the clinical characteristics and outcomes in cardiac non-Hodgkin's lymphoma (NHL).
Methods:
A retrospective analysis of 94 cases of NHL with biopsy-proven cardiac involvement in PubMed between 1990 and 2015.
Results:
Among cases with cardiac involvement, diffuse large B-cell lymphoma was the most common histologic subtype (58%), followed by T-cell lymphoma (16%), Burkitt's lymphoma (9%), and small lymphocytic lymphoma (6%). Symptomatic heart failure was the most common clinical presentation (34%), and 20% of patients had no cardiac symptoms. Median survival was 3 months (range, 0-72) among all patients. Patients who presented with heart failure had inferior outcomes. Patients with primary, vs. secondary, cardiac involvement had a trend toward superior outcomes. Importantly, chemotherapy treatment was associated with a prolongation in median survival (18 vs. 1 month, HR 0.16, 95% CI, 0.47-0.54, P = 0.0003), and patients diagnosed in the chemo-immunotherapy era demonstrated a trend toward better outcomes. Median survival was not reached among patients with B-cell malignancies who were alive for 1 month after the diagnosis.
Conclusion:
Pathologic lymphomatous involvement of cardiac tissue should be considered in the evaluation of patients with NHL. Durable remissions can be achieved in B-cell NHL with cardiac involvement, and thus, therapy should be considered in such cases.
