Key result
Anthracycline-free chemoimmunotherapy achieves remission and 18-month recurrence-free survival in post-LAA closure FO-LBCL.
Why the study?
Fluid overload-associated large B-cell lymphoma (FO-LBCL) is a rare malignancy that presents with serous effusions without solid masses and can mimic device-related complications after left atrial appendage closure.
Case Report (n=1)
No
This case highlights the necessity of excluding malignancies in late pericardial effusions following left atrial appendage closure and demonstrates that an attenuated, anthracycline-free chemoimmunotherapy regimen can achieve remission in elderly patients with fluid overload-associated large B-cell lymphoma and high cardiovascular risk.
Answers are grounded in this paper and cite their sources.
Pericardial effusion after LAA closure may indicate FO-LBCL rather than device complication; this case extends the spectrum of serous effusions in this rare lymphoma.
BACKGROUND: Fluid overload-associated large B-cell lymphoma (FO-LBCL) is a rare malignancy presenting with serous effusions without solid masses. CASE SUMMARY: We report an 83-year-old man developing substantial pericardial effusion 19 months post-left atrial appendage closure. Although a device-related complication was initially suspected, pericardial fluid analysis and fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography established a definitive diagnosis of FO-LBCL. Because of severe cardiovascular comorbidities and anthracycline cardiotoxicity risks, standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone was contraindicated. Instead, an individualized, anthracycline-free regimen with 3 cycles of rituximab monotherapy followed by 3 cycles of rituximab, cyclophosphamide, vincristine, and prednisolone cycles was administered. The patient achieved remission and remained recurrence-free during 18-month follow-up. TAKE-HOME MESSAGE: The present case highlights the critical need to exclude malignancies in post-left atrial appendage closure effusions and demonstrates the efficacy of attenuated, anthracycline-free chemoimmunotherapy for elderly patients with FO-LBCL high cardiovascular risk.
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Gu et al. (2026) conducted a case report in Fluid overload-associated large B-cell lymphoma (FO-LBCL) presenting as pericardial effusion post-left atrial appendage closure (n=1). Anthracycline-free chemoimmunotherapy (rituximab monotherapy followed by R-CVP) was evaluated on Disease remission and recurrence-free survival. Anthracycline-free chemoimmunotherapy (3 cycles rituximab + 3 cycles R-CVP) achieved remission and 18-month recurrence-free survival in an 83-year-old man with FO-LBCL post-LAA closure.
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