TY - JOUR
T1 - Primary cardiac lymphoma with isolated parenchymal central nervous system relapse
T2 - Report of two cases and review of the literature
AU - Montoro, Juan
AU - Mattia, Lucia
AU - Bertazzoni, Paola
AU - Liptrott, Sarah
AU - Colombo, Nicola
AU - Civelli, Maurizio
AU - Preda, Lorenzo
AU - Laszlo, Daniele
AU - Martinelli, Giovanni
AU - Frungillo, Niccolò
PY - 2014/10/23
Y1 - 2014/10/23
N2 - Primary cardiac lymphoma (PCL) is a rare subset of non-Hodgkin's lymphoma involving the heart and/or pericardium with no or minimal evidence of extracardiac involvement at presentation. Distant relapses have infrequently been observed. We report two cases of this disorder that showed isolated central nervous system (CNS) relapse. Diagnosis by endomyocardial biopsy was consistent with diffuse large B-cell lymphoma. After immunochemotherapy they achieved complete remission (CR). Eight and five weeks after, isolated CNS relapses were observed respectively. The first patient was treated with high-dose methotrexate (HD-MTX) and high-dose cytarabine, resulting in a second CR. She then went onto receive autologous stem-cell transplantation but unfortunately died shortly after because of infection. The second patient received systemic CNS prophylaxis with HD-MTX, and later she was treated with an induction chemotherapy strategy with evidencing of progressive disease after two courses of treatment. She was subsequently initiated on a salvage therapy with cytarabine, followed by whole-brain radiotherapy, and autologous stem-cell transplant (ASCT), finally achieving a complete remission. Isolated CNS relapse is a very uncommon pattern in PCL and a standard approach to treatment is not yet well established. Nevertheless, the importance of CNS evaluation, using magnetic resonance imaging (MRI) and lumbar puncture, in patients with PCL should be considered, and further studies are recommended to determine the appropriate management of this complication.
AB - Primary cardiac lymphoma (PCL) is a rare subset of non-Hodgkin's lymphoma involving the heart and/or pericardium with no or minimal evidence of extracardiac involvement at presentation. Distant relapses have infrequently been observed. We report two cases of this disorder that showed isolated central nervous system (CNS) relapse. Diagnosis by endomyocardial biopsy was consistent with diffuse large B-cell lymphoma. After immunochemotherapy they achieved complete remission (CR). Eight and five weeks after, isolated CNS relapses were observed respectively. The first patient was treated with high-dose methotrexate (HD-MTX) and high-dose cytarabine, resulting in a second CR. She then went onto receive autologous stem-cell transplantation but unfortunately died shortly after because of infection. The second patient received systemic CNS prophylaxis with HD-MTX, and later she was treated with an induction chemotherapy strategy with evidencing of progressive disease after two courses of treatment. She was subsequently initiated on a salvage therapy with cytarabine, followed by whole-brain radiotherapy, and autologous stem-cell transplant (ASCT), finally achieving a complete remission. Isolated CNS relapse is a very uncommon pattern in PCL and a standard approach to treatment is not yet well established. Nevertheless, the importance of CNS evaluation, using magnetic resonance imaging (MRI) and lumbar puncture, in patients with PCL should be considered, and further studies are recommended to determine the appropriate management of this complication.
KW - Central nervous system
KW - Diffuse large B-cell lymphoma
KW - Primary cardiac lymphoma
UR - http://www.scopus.com/inward/record.url?scp=84908236795&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84908236795&partnerID=8YFLogxK
U2 - 10.3332/ecancer.2014.474
DO - 10.3332/ecancer.2014.474
M3 - Article
AN - SCOPUS:84908236795
VL - 8
JO - ecancermedicalscience
JF - ecancermedicalscience
SN - 1754-6605
M1 - 474
ER -