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Case Reports
. 2023 Jan 30:13:1091074.
doi: 10.3389/fonc.2023.1091074. eCollection 2023.

Relapsed/refractory diffuse large B cell lymphoma with cardiac involvement: A case report and literature review

Yuanyuan Yang  1   2 , Zixuan Li  1   2 , Yuntao Li  1   2 , Yue Zhao  3 , Mingxia Shi  1   2
Affiliations
Case Reports

Relapsed/refractory diffuse large B cell lymphoma with cardiac involvement: A case report and literature review

Yuanyuan Yang et al. Front Oncol. .

Abstract

Background: Hematological malignancies of the heart (CHMs) are extremely rare, and include leukemia, lymphoma infiltration, and multiple myeloma with extramedullary manifestations. Cardiac lymphoma can be divided into primary cardiac lymphoma (PCL) and secondary cardiac lymphoma (SCL). Compared to PCL, SCL is relatively more common. Histologically, the most frequent SCL is diffuse large B-cell lymphoma (DLBCL). The prognosis of lymphoma in patients with cardiac involvement is extremely poor. CAR T-cell immunotherapy has been recently become a highly effective treatment for relapsed or refractory diffuse large B-cell lymphoma. To date, there are no guidelines that provide a clear consensus on the management of patients with secondary heart or pericardial involvement. We report a case of relapsed/refractory DLBCL that secondarily affected the heart.

Case presentation: A male patient was diagnosed with double-expressor DLBCL based on biopsies of mediastinal and peripancreatic masses and fluorescence in situ hybridization. The patient received first-line chemotherapy and anti-CD19 CAR T cell immunotherapy, but developed heart metastases after 12 months. Considering his physical condition and economic situation of the patient, two cycles of multiline chemotherapies were administered, followed by CAR-NK cell immunotherapy and allogeneic hematopoietic stem cell transplantation (allo-HSCT) at another hospital. After achieving a six-month survival, the patient died of severe pneumonia.

Conclusion: The response of our patient emphasizes the importance of early diagnosis and timely treatment to improve the prognosis of SCL and serves as an important reference for SCL treatment strategies.

Keywords: B-cell lymphoma; CAR T-cell immunotherapy; cardiac hematological malignancy; case report; secondary cardiac lymphoma.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
At diagnosis of lymphoma, a PET-CT scan and a biopsy were performed. (A-C) PET/CT revealed multiple enlarged lymph nodes in the middle and upper mediastinum and the maximum plane size was approximately 6.3 cm x 4.3 cm. There were masses showing infiltration around the ascending aorta and pulmonary artery. The SUVmax was 13.8. (D) PET/CT revealed the uncinate process of pancreas infiltration, with a diameter of about 2 cm and the SUVmax was 5.7. (E, F) Overall, there is no significant abnormal radiation uptake outside of the pancreas and mediastinal lymph nodes. (G)The hematoxylin-eosin staining revealed medium to large cells with irregular nucleus in the pancreas (original magnification 10 x). (H, I) The hematoxylin-eosin staining revealed medium to large cells with irregular nucleus in the mediastinum (H:original magnification 10 x; G:original magnification 20 x).
Figure 2
Figure 2
The patient experienced dyspnea and had a refractory bilateral pleural effusion after receiving multi-line chemotherapy. Transthoracic echocardiography showed the heart infiltrated by lymphoma. (A) Long axis section of left ventricle showing a slight hypoechoic mass in the anterior wall of the left atrium. (B) Lateral wall of left atrium and left atrial appendage were infiltrated. (C, D) Four-chamber view showed pulmonary vein infiltration. Cardiac ventricular opacification (CVO): (E, F) An irregular mass was present at the entrance of pulmonary veins in the left atrium with rapid irregular perfusion and complete enhancement. (LV: Left Ventricle; RA: Right Atrium; RV: Right Ventricle; LA: Left Atrium).
Figure 3
Figure 3
Statistical analysis of the data in the literature review (–48) and the timeline of disease status and corresponding treatment regimens of our patient. (A) Timeline of disease status and corresponding treatment regimens. (B) Pie chart of tissue type composition of secondary cardiac lymphoma. (DLBCL, diffuse large B-cell lymphoma; MZL, marginal zone lymphoma; MCL, mantle cell lymphoma; T-cell: T cell lymphoma). (C) Kaplan-Meier survival curves for secondary cardiac lymphomas comparing DLBCL with other cancers included in the statistics. (CI, confidence interval).
See this image and copyright information in PMC

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