What does this research mean for the field?

Rapid initiation of high-intensity chemotherapy is feasible and can yield rapid clinical improvement in patients with aggressive primary cardiac lymphoma presenting as acute heart failure, despite a high risk of subsequent relapse. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To describe the diagnostic evaluation and treatment response of a patient presenting with acute heart failure and pericarditis caused by primary cardiac lymphoma.

April 20, 2026Cardio-OncologyOpen Access

Chemotherapy-responsive primary cardiac lymphoma presenting as pericarditis and acute heart failure

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Why the study?

Primary cardiac lymphomas are rare malignancies, making a standard of care difficult to establish.

Key Points

To describe the diagnostic evaluation and treatment response of a patient presenting with acute heart failure and pericarditis caused by primary cardiac lymphoma.
Evaluated a middle-aged male presenting with chest pain, dyspnea, and suspected pericarditis using transthoracic echocardiography, cross-sectional imaging, and tissue biopsy.
Administered dose-adjusted multiagent chemotherapy with daEPOCH-R (etoposide, prednisone, cyclophosphamide, vincristine, and rituximab), adding doxorubicin once cardiac ejection fraction normalized.
Treatment with daEPOCH-R achieved rapid clinical improvement, reduction of tumor markers, and complete resolution of the obstructive right atrial mass.
The patient developed central nervous system relapse 3 months after chemotherapy completion, which responded to therapy while awaiting autologous stem cell transplantation.

Structured PICO

Population

1 patient (n=1), 55-year-old male with primary cardiac lymphoma (high-grade B-cell lymphoma, double-hit) presenting as pericarditis and acute heart failure.

Intervention

daEPOCH-R multiagent chemotherapy (etoposide, prednisone, cyclophosphamide, vincristine, rituximab, and later doxorubicin), followed by high-dose methotrexate and cytarabine for CNS relapse.

Outcome

Clinical improvement and resolution of cardiac mass.

Rapid initiation of high-intensity chemotherapy like daEPOCH-R is feasible and can lead to complete resolution of aggressive primary cardiac lymphoma presenting with acute heart failure.

Discussion

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Implication

Promotes prompt imaging and biopsy in atypical pericarditis; leaves open optimal management of primary cardiac lymphoma.

Cite This Study

Schilthuis et al. (2026) studied this question.

synapsesocial.com/papers/69e5c3ec03c2939914029b4d https://doi.org/10.1186/s40959-026-00487-x

Topics

Pericardial disease Heart failure HFrEF treatment

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Chemotherapy-responsive primary cardiac lymphoma presenting as pericarditis and acute heart failure

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Chemotherapy-responsive primary cardiac lymphoma presenting as pericarditis and acute heart failure

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

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