Key result
R-CHOP chemotherapy resolves cardiac lymphoma and reduces LV wall thickness from 29 to 12 mm.
Why the study?
Primary cardiac lymphoma is an extremely rare malignancy with poor prognosis if untreated, and left-sided cardiac involvement is especially uncommon.
Case Report (n=1)
No
Early recognition and treatment with R-CHOP chemotherapy can lead to complete metabolic response and resolution of cardiac masses in rare cases of primary cardiac lymphoma with left heart involvement.
Answers are grounded in this paper and cite their sources.
May support R-CHOP in rare primary cardiac DLBCL; hypothesis-generating and leaves broader applicability open.
Background: Primary cardiac lymphoma is an extremely rare malignancy involving the heart and pericardium. It is a disease that most commonly effects the right atrium and right ventricle. Left untreated it carries a very poor prognosis. Recent advancements in therapy including early recognition and initiation of chemotherapy has led to improved survival. Case summary: A 78 year old female presented with weight loss, abdominal pain and distension. An ultrasound abdomen pre admission showed abdominal ascites. An echocardiogram performed during admission showed a large pericardial effusion with asymmetrical increase in left ventricular wall thickness and a new left atrial mass. Pericardial fluid analysis led to the diagnosis of diffuse large B cell non-Hodgkin's lymphoma. Positron Emission Tomography CT (PET-CT) shows avid fluorodeoxyglucose (FDG) uptake in cardiac muscle. Prompt treatment was initiated with a chemotherapy regimen involving Rituximab, Cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). An echocardiogram 3 months post initiation of treatment showed resolution of the pericardial effusion and left atrial mass as well as an improvement in left ventricular wall thickness. A PET-CT following completion of treatment showed complete metabolic response. Discussion: The diagnosis of primary cardiac lymphoma is uncommon and the presence of left rather than right heart involvement is rarer still. Multimodality imaging is key in diagnosis. Early recognition and treatment is vital in improving associated morbidity and mortality.
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Ellen et al. (2023) conducted a case report in Primary cardiac lymphoma (diffuse large B-cell lymphoma) (n=1). R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) was evaluated on Resolution of cardiac lymphoma (pericardial effusion, left atrial mass, left ventricular wall thickness, and metabolic response on PET-CT). R-CHOP chemotherapy resolved the pericardial effusion and left atrial mass, reduced LV wall thickness from 29 mm to 12 mm at 3 months, and achieved complete metabolic response at 6 months.
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