Efficacy of Rituximab Monotherapy for an Elderly Hemodialysis Patient with Primary Cardiac Lymphoma

Abstract

We report a case of primary cardiac lymphoma (PCL) occurring in a 76-year-old man during maintenance hemodialysis. Chest computed tomography (CT) revealed a tumor with pericardial effusion in the left ventricular posterior wall. Cytological examination of the pericardial fluid revealed monotonous lymphoid cells positive for B-cell markers, and clonal immunoglobulin heavy chain gene rearrangement was detected, indicating B-cell lymphoma. Rituximab monotherapy was administered biweekly at the therapeutic level on hemodialysis. The follow-up chest CT showed tumor disappearance with pericardial fluid after two courses of therapy. Rituximab monotherapy was effective for an elderly hemodialysis patient with PCL.

The diagnosis of primary cardiac lymphoma was facilitated by computed tomographic coronary angiography

“…However, PCL is classified mainly as DLBCL (60–80% of cases), and DLBCL has a good response to well-tolerated chemotherapy [ 2 ]. After eight cycles of R-CHOP every 3 weeks for Stage III or IV DLBCL, patients with a performance status of 0–2 showed a complete response rate of 76%, a 2-year survival rate of 70% and 80% of patients are able to undergo scheduled therapy [ 4 ].…”

“…After eight cycles of R-CHOP every 3 weeks for Stage III or IV DLBCL, patients with a performance status of 0–2 showed a complete response rate of 76%, a 2-year survival rate of 70% and 80% of patients are able to undergo scheduled therapy [ 4 ]. Morita et al [ 2 ] reported the use of rituximab monotherapy for an elderly hemodialysis patient with PCL, and indicated that it led to a good response and improvement of the symptoms without serious adverse effects. Unfortunately, the tumor in our case relapsed.…”

“…Primary cardiac lymphoma (PCL) is a rare entity that comprises only 0.5% of extranodal lymphomas [ 1 ] and accounts for only 1.3% of cardiac tumors [ 2 ]. This tumor leads to fatal symptoms, such as congestive heart failure, pericardial effusion or arrhythmia [ 3 ].…”

“…This tumor leads to fatal symptoms, such as congestive heart failure, pericardial effusion or arrhythmia [ 3 ]. Once a diagnosis of this tumor is made, chemotherapy can often improve the patient's prognosis [ 2 ]. However, the fact that there are few specific findings of this tumor and the poor condition of the patient often makes an antemortem diagnosis difficult [ 1 , 2 ].…”

Gestion des thérapies ciblées chez les patients hémodialysés

“…Il ne semble donc pas nécessaire d'adapter la posologie du rituximab chez le patient dialysé [12,13]. Le rituximab n'est pas dialysable en hémodialyse [8,14]. L'administration du médicament peut donc être réalisée indifféremment avant ou après la séance d'hémodialyse ou bien un jour sans dialyse.…”