Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 36716  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::  Article in PDF (669 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  References
 ::  Article Figures

 Article Access Statistics
    Viewed327    
    Printed16    
    Emailed0    
    PDF Downloaded10    
    Comments [Add]    

Recommend this journal


 


 
  Table of Contents     
CASE SNIPPET
Year : 2020  |  Volume : 66  |  Issue : 3  |  Page : 176-177

Isolated intracardiac recurrence of diffuse large B-cell lymphoma successfully treated with rituximab and bendamustine chemotherapy regimen


1 Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
2 Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Date of Submission20-Dec-2019
Date of Decision02-Mar-2020
Date of Acceptance23-Apr-2020
Date of Web Publication14-Jul-2020

Correspondence Address:
C H Chang
Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
Taiwan
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpgm.JPGM_683_19

Rights and Permissions




How to cite this article:
Chang C H, Lin C S, Ho C L. Isolated intracardiac recurrence of diffuse large B-cell lymphoma successfully treated with rituximab and bendamustine chemotherapy regimen. J Postgrad Med 2020;66:176-7

How to cite this URL:
Chang C H, Lin C S, Ho C L. Isolated intracardiac recurrence of diffuse large B-cell lymphoma successfully treated with rituximab and bendamustine chemotherapy regimen. J Postgrad Med [serial online] 2020 [cited 2020 Oct 24];66:176-7. Available from: https://www.jpgmonline.com/text.asp?2020/66/3/176/289766




A 72-year-old man with a history of diffuse large B-cell lymphoma (DLBCL) in the lumbar spine, Ann Arbor stage II status post chemotherapy with rituximab, cyclophosphamide, vincristine, and prednisolone (R-COP) and local radiotherapy, had been in complete remission for 4 years. He presented to our emergency department after experiencing exertional dyspnea for 1 week. Physical examination revealed bilateral basal rales, jugular vein engorgement, and bilateral edema of the lower limbs. Chest radiography showed bilateral pleural effusion, cardiomegaly, and pulmonary trunk engorgement. Blood investigations revealed thrombocytopenia (platelet counts of 54000/μL, normal range: 150000–400000/μL) and high levels of lactate dehydrogenase (787 U/L, normal range: 140–271 U/L) and B-type natriuretic peptide (819 pg/mL, normal level: <100 pg/mL). Room air arterial blood gas analyses revealed a PaCO2 of 27.7 mmHg (normal range: 35–45 mmHg), PaO2 of 64.1 mmHg (normal range: 75–100 mmHg) and HCO3 level of 23 mmol/L. Other laboratory data were unremarkable. After an initial diagnosis of possible acute decompensated heart failure, intravenous furosemide, and nitroglycerin were initiated. However, facial swelling and edema in upper limbs, along with worsening tachycardia, and orthopnea, developed after this therapy. Contrast-enhanced computed tomography (CECT) of the chest demonstrated soft-tissue masses impacted in the pulmonary vein, right atrium, right ventricle, and left atrium, accompanied by large amounts of pericardial effusion [Figure 1]. This led us to suspect superior vena cava syndrome caused by intracardiac tumors for which steroid treatment was initiated. A biopsy was recommended. However, as the patient refused this procedure due to his advanced age, intravenous betamethasone was prescribed, followed by the rituximab and bendamustine (RB) regimen. After 3 months, the CT of the chest revealed reduced tumor sizes [Figure 2]. Positron emission tomography revealed a positive response of DLBCL to chemotherapy as evidenced by the low fluorodeoxyglucose (FDG) uptake [Figure 3] indicating a reduction in metabolism in the tumors. The patient was free of symptoms and was referred to the outpatient department for further follow-up..
Figure 1: Contrast-enhanced computed tomography (CECT) of the chest showing masses occupying the right atrium, right ventricle, and left atrium with extensive pericardial effusion and bilateral pleural effusion

Click here to view
Figure 2: CT of the chest after chemotherapy with six cycles of the rituximab and bendamustine regime revealing reduced tumor sizes

Click here to view
Figure 3: PET CT image posttreatment showing reduction of metabolic activity in the intracardiac lymphoma consistent with a response to therapy. Soft-tissue masses impacted in the heart showing little FDG uptake (SUVmax: 1.2)

Click here to view


DLBCL is the most common type of non-Hodgkin lymphoma and can be cured using immunochemotherapy.[1] Although it can recur at nodal or extranodal sites, such as the gastrointestinal tract, testes, thyroid, skin, breast, bone, or brain, isolated intracardiac recurrence is extremely rare. However, most cardiac lymphomas are DLBCL and involve the right side of the heart, particularly the right atrium.[2] Approximately 5–8% of patients with DLBCL present with superior vena cava syndrome.[2] The treatment of cardiac lymphoma is not without challenges as the preferred curative protocol for a patient with a recurrent DLBCL is salvage chemotherapy—the common salvage chemotherapy regimens used are rituximab, dexamethasone, high-dose Ara-C and platinol (RDHAP), or rituximab, gemcitabine, carboplatin and dexamethasone (RGCD) or rituximab and bendamustine (RB).[2],[3],[4] This treatment is frequently followed by an autologous transplant; however, surgical intervention or autologous transplant may not be a viable option, particularly for frail or elderly patients. Hence, chemotherapy with the RB regimen may be considered to be an alternative treatment protocol for patients with recurrent DLBCL, post-R-CHOP. Our successful experience highlights the therapeutic potential of the RB regimen in patients with advanced intracardiac lymphoma, particularly in those unsuited to surgical intervention.

Declaration of patient consent

The authors certify that appropriate patient consent was obtained.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 :: References Top

1.
Wang Y, Farooq U, Link BK, Larson MC, King RL, Maurer MJ, et al. Late relapses in patients with diffuse large B-cell lymphoma treated with immunochemotherapy. J Clin Oncol 2019;37:1819-27.  Back to cited text no. 1
    
2.
Jeudy J, Burke AP, Frazier AA. Cardiac lymphoma. Radiol Clin North Am 2016;54:689-710.  Back to cited text no. 2
    
3.
Amari K, Tago M, Katsuki NE, Fukumori N, Yamashita SI. Cardiac recurrence of diffuse large B-cell lymphoma more than a decade after attaining complete remission. Am J Case Rep 2018;19:1057-62.  Back to cited text no. 3
    
4.
Jonavicius K, Salcius K, Meskauskas R, Valeviciene N, Tarutis V, Sirvydis V. Primary cardiac lymphoma: Two cases and a review of literature. J Thorac Cardiovasc Surg 2015;10:138-42.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
Print this article  Email this article
 
Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow