Cardiac Metastasis in Diffuse Large B Cell Lymphoma: Article Review

Abstract

Diffuse Large B Cell Lymphoma (DLBCL) is the most common subtype of non-Hodgkin's lymphoma that metastasizes to the heart. It was considered rare and was detected mainly at autopsy, but the prevalence has risen in recent times. The prognosis is poor if left untreated. Although most cases respond to chemotherapy well, the treatment can be associated with life-threatening complications including ventricular fibrillation, pulmonary embolism, and cardiac rupture early after chemotherapy. Little data is available regarding the optimal approach. A reduced chemotherapy dose was reported in several cases to decrease the risk of complications however, the inadequate treatment of cancer remains a concern. Moreover, chimeric T-cell (CAR-T cell) therapy resulted in significant improvement in other cases. In this manuscript, we intend to explore the symptoms and treatment of DLBCL with cardiac metastasis and the resulting outcomes. Our study includes 29 published cases older than 18 years with DLBCL who were diagnosed with cardiac metastasis. In 50% of cases, cardiac metastasis was detected at the initial presentation and diagnosis of lymphoma. Shortness of breath was the most common manifestation. 80.7 % of the cases underwent isolated chemotherapy and signs of improvement were reported as early as 1 month. Reduced chemotherapy dose was performed just in one case for the first cycle. Five out of 29 patients expired despite treatment. Arrhythmia was the cause of death in one patient. CAR-T cell, which was performed in 3 cases with resistance to chemotherapy, was associated with favorable outcomes.