Spontaneous Resolution of Chylothorax-Associated Lymphoma Treated with External Beam Radiotherapy: A Case Report and Comprehensive Review of the Literature

Jm, Laba; Tk, Nguyen; Boldt, Gabriel; Av, Louie

doi:10.7759/cureus.761

Cited by 5 publications

(5 citation statements)

References 22 publications

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“…Furthermore, interactions between the lymphatic system, the tumor characteristics as well as the body's reaction to the disease and treatment may also be additional factors in the development of chylous effusions not yet understood [ 15 – 17 ].…”

Section: Discussionmentioning

confidence: 99%

Interventional treatment of refractory non-traumatic chylous effusions in patients with lymphoproliferative disorders

Wagenpfeil,

Hoß,

Henkel

et al. 2024

Clin Exp Med

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To report results of interventional treatment of refractory non-traumatic abdomino-thoracic chylous effusions in patients with lymphoproliferative disorders. 17 patients (10 male; mean age 66.7 years) with lymphoproliferative disorders suffered from non-traumatic chylous effusions (chylothorax n = 11, chylous ascites n = 3, combined abdomino-thoracic effusion n = 3) refractory to chemotherapy and conservative therapy. All underwent x-ray lymphangiography with iodized-oil to evaluate for and at the same time treat lymphatic abnormalities (leakage, chylo-lymphatic reflux with/without obstruction of central drainage). In patients with identifiable active leakage additional lymph-vessel embolization was performed. Resolution of effusions was deemed as clinical success. Lymphangiography showed reflux in 8/17 (47%), leakage in 2/17 (11.8%), combined leakage and reflux in 3/17 (17.6%), lymphatic obstruction in 2/17 (11.8%) and normal findings in 2/17 cases (11.8%). 12/17 patients (70.6%) were treated by lymphangiography alone; 5/17 (29.4%) with leakage received additional embolization (all technically successful). Effusions resolved in 15/17 cases (88.2%); 10/12 (83.3%) resolved after lymphangiography alone and in 5/5 patients (100%) after embolization. Time-to-resolution of leakage was significantly shorter after embolization (within one day in all cases) than lymphangiography (median 9 [range 4–30] days; p = 0.001). There was no recurrence of symptoms or post-interventional complications during follow-up (median 445 [40–1555] days). Interventional-radiological treatment of refractory, non-traumatic lymphoma-induced chylous effusions is safe and effective. Lymphangiography identifies lymphatic abnormalities in the majority of patients and leads to resolution of effusions in > 80% of cases. Active leakage is found in only a third of patients and can be managed by additional embolization.

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Section: Discussionmentioning

confidence: 99%

Interventional treatment of refractory non-traumatic chylous effusions in patients with lymphoproliferative disorders

Wagenpfeil,

Hoß,

Henkel

et al. 2024

Clin Exp Med

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“…This results in the backflow of lymph fluid into the parietal pleura through the lymphatics and then into the pleural cavity. This pressure also forms collateral canals that dilate and open the pleural cavity [16] , [17] . Another theory states that a large number of lymphocytes and protein material in the lymph fluid in patients with lymphoma and leukemia can cause a high viscosity of the lymph fluid.…”

Section: Discussionmentioning

confidence: 99%

Indonesian female with bilateral chylothorax and mediastinal non-Hodgkin lymphoma: A case report

Wijaya

Koesoemoprodjo

2023

International Journal of Surgery Case Reports

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“…The etiologies of nontraumatic chylothorax include hematologic malignancy, sarcoidosis, amyloidosis, and lymph vessels disorder. [ 20 , 21 ] Chylothorax are conventionally treated with radiologic intervention and surgical modalities. In cases of drug-induced chylothorax, symptoms were resolved by discontinuing the medication.…”

Section: Discussionmentioning

confidence: 99%

Chylothorax after chimeric antigen receptor T cell therapy for relapsed and refractory diffuse large B-cell lymphoma: A case report

Chen,

Kuo,

et al. 2023

Medicine

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Rationale: Anti-CD19-targeted chimeric antigen receptor (CAR) T cell therapy is effective in treating relapsed/refractory diffuse large B-cell lymphoma (DLBCL). This therapy is associated with several side effects that can be life-threatening such as cytokine release syndrome (CRS). However, chylothorax associated with CRS after CAR-T therapy has not been reported. Patient concerns: A 23-year-old male diagnosed with DLBCL relapsing after autologous peripheral blood stem cell transplantation was treated with anti-CD19-targeted CAR-T cell therapy. After CAR-T cell transfusion, he developed grade 3 CRS includes fever, dyspnea, tachycardia and hypotension. The symptoms of CRS persisted and chest plain film revealed bilateral pleural effusion. Diagnosis: Chylothorax was confirmed by the pleural effusion analysis that triglyceride level was 1061 mg/dL. Bacterial and fungal culture of pleural fluid reported no pathogen was detected. Cytological examination of pleural effusion revealed no malignant cells. Interventions: The chylothorax resolved after treatment with intravenous administration of tocilizumab. Outcomes: On 30-day follow-up, the patient was in stable clinical condition with complete remission of DLBCL on whole-body positron emission tomography scan. Lessons: We reported a rare case of CAR-T associated chylothorax in a patient with relapsed and refractory DLBCL. Grade 3 CRS with high interleukin-6 level was presented in our patient. The symptoms of CRS were improved with tocilizumab treatment and the chylothorax resolved later on. It is suggested that high interleukin-6 releases might induce chyle leakage resulting from activations of endothelium and coagulation. Our finding highlights the occurrence of chylothorax during the course of CAR-T cell therapy and the importance of proper monitoring and prompt management of this life-threatening side effect.

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Spontaneous Resolution of Chylothorax-Associated Lymphoma Treated with External Beam Radiotherapy: A Case Report and Comprehensive Review of the Literature

Cited by 5 publications

References 22 publications

Interventional treatment of refractory non-traumatic chylous effusions in patients with lymphoproliferative disorders

Interventional treatment of refractory non-traumatic chylous effusions in patients with lymphoproliferative disorders

Indonesian female with bilateral chylothorax and mediastinal non-Hodgkin lymphoma: A case report

Chylothorax after chimeric antigen receptor T cell therapy for relapsed and refractory diffuse large B-cell lymphoma: A case report

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