Treatment with doxorubicin-based protocol in cardiac involvement diffuse large B-cell lymphoma: A case report
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A Doxorubicin-Induced Murine Model of Dilated Cardiomyopathy In Vivo
Published on: May 16, 2020
Atakan Tekinalp1, Taha U Kars1, Hatice Z Dikici1
1Department of Internal Medicine Division of Hematology Konya, 427826Necmettin Erbakan University Meram Faculty of Medicine, Turkey.
Insights
Cardiac involvement in diffuse large B-cell lymphoma is rare and can cause heart failure. Early chemotherapy is crucial for symptomatic patients, with careful cardiac function monitoring during treatment.
Area of Science:
- Cardiology
- Hematology
- Oncology
Background:
- Cardiac involvement in diffuse large B-cell lymphoma (DLBCL) is uncommon in non-Hodgkin lymphomas.
- Symptoms typically manifest as heart failure due to cardiac mass.
- Prompt treatment is essential for severely symptomatic patients with cardiac involvement.
Observation:
- A 61-year-old female with gastric DLBCL presented with a large intra-atrial septum mass extending to the inferior vena cava.
- Staging revealed Stage III disease, high-risk group, and significant heart failure.
- Echocardiography showed a 60% ejection fraction, but doxorubicin treatment posed cardiac risks due to age and hypertension.
Findings:
- Complete remission was achieved after three cycles of a rituximab-cyclophosphamide-doxorubicin-vincristine and methylprednisolone regimen.
- The patient completed six cycles and was monitored for three months post-treatment.
Implications:
- Doxorubicin-based chemotherapy protocols carry cardiotoxicity risks.
- Pre-treatment and ongoing cardiac function evaluation are critical for patients undergoing chemotherapy.
- This case highlights the importance of managing cardiac function in DLBCL patients receiving cardiotoxic agents.
Introduction:
Cardiac involvement in diffuse large B-cell lymphoma is a rare entity in non-Hodgkin lymphomas. Symptoms are usually related to heart failure. Patients who are severely symptomatic due to cardiac mass could be considered treatment as soon as possible. In this report, we present a patient diagnosed with diffuse large B-cell lymphoma with cardiac involvement.
Case Report:
A 61-year-old female patient was admitted to our unit with gastric biopsy diffuse large B-cell lymphoma. Computerized tomography of the chest and positron emission tomography/computed tomography demonstrated a neoplastic mass in the intra-atrial septum extended to inferior vena cava (5 × 4 cm in size and standardized uptake value maximum 24.6). She was in stage III and in the high-risk group. Because of pronounced heart failure findings associated with the mass-specific chemotherapy was planned early.
Management & Outcome:
Although a fraction of ejection was 60% by echocardiography before the treatment, she had a cardiac risk for doxorubicin due to being over 60 years old and hypertension. Complete remission was achieved after three cycles of rituximab-cyclophosphamide-doxorubicin-vincristine and methylprednisolone protocol including doxorubicin. Treatment was completed with six cycles and she was followed up for three months.
Discussion:
Because of the cardiotoxicity of doxorubicin-based protocols, patients should be evaluated according to cardiac functions before and during the chemotherapy.
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