Experiences in the treatment of refractory chylothorax associated with lymphoproliferative disorders

Pospiskova, Jana; Smolej, Lukáš; Belada, David; Šimkovič, Martin; Motyčková, Monika; Šýkorová, Alice; Štěpánková, Pavla; Зак, Павел

doi:10.1186/s13023-018-0991-3

Cited by 13 publications

(15 citation statements)

References 32 publications

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“…The major etiology of non-traumatic chylothorax is malignancy of which lymphoma is one of the most common causes [11]. Indolent lymphomas like follicular and mantle cell lymphoma have been reported to cause chylothorax more often than the aggressive ones like diffuse large B-cell lymphoma [12]. Other lymphoprofilerative disorders like chronic lymphocytic leukemia have also been implicated in the etiology of chylothorax [13].…”

Section: Discussionmentioning

confidence: 99%

Primary Pleural Extranodal Marginal Zone Lymphoma Presenting as Bilateral Chylothorax

et al. 2020

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Here we describe a case of pleural extranodal marginal zone lymphoma presenting as bilateral chylothorax which has not been reported in the literature prior to this. Primary pleural lymphomas are a rare entity most commonly associated with chronic infections, autoimmune conditions or long-standing pyothorax which were not seen in this case. Chylous pleural effusions in this patient were successfully managed with chemotherapy for the underlying lymphoma.

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Section: Discussionmentioning

confidence: 99%

Primary Pleural Extranodal Marginal Zone Lymphoma Presenting as Bilateral Chylothorax

et al. 2020

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“…Up to now, the mechanism and treatment of chylous exudation are not clear. Effective chemotherapy is conducive to the spontaneous absorption of pleural effusion, which may solve the problem of chylothorax associated with hematological malignancies (4,5).…”

Section: Introductionmentioning

confidence: 99%

“…Although previous experience has implied that auxiliary interventions, such as low-fat diet and parenteral nutrition, are important for the recovery of patients (2,5). The main factor affecting the treatment of chylothorax is whether the anti-cancer treatment aimed at the primary disease is effective.…”

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confidence: 99%

“…Treatment of chylothorax usually lasts several months and is affected by the duration of chylothorax, the extent of chylothorax loss, and the general condition of the patient (14). Experiences from a retrospective study of chylothorax with lymphoproliferative disease showed that the average clearance time of chylothorax was 73 days after receiving anti-cancer treatment (5). For complex cases, other treatments besides chemotherapy should be considered.…”

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confidence: 99%

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Complete resolution of chylothorax with ibrutinib in chronic lymphocytic leukemia: a case report

Cheng¹,

Huang²,

Wei³

et al. 2022

Ann Palliat Med

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Chylothorax is an infrequent pleural effusion often caused by traumatic or nontraumatic injury to the thoracic duct. Nontraumatic chylothorax caused by chronic lymphocytic leukemia (CLL) is rarely reported. Previous experience has implied that the main factor affecting the treatment of chylothorax is whether the anti-cancer treatment is effective. The patient diagnosed with chronic lymphocytic leukemia/ small lymphocytic lymphoma (CLL/SLL) before the hospital admission, and not received any treatment.After four months, he had progressive dyspnea. Chest computed tomography (CT) scan showed bilateral pleural effusion with progressive lymphadenopathy, and massive chylous pleural effusion was drained by closed thoracic drainage. After a course of chemotherapy including fludarabine, cyclophosphamide and rituximab (FCR), the patient developed agranulocytosis and his pleural effusion was still abundant. After careful consideration, the patient refused to receive following chemotherapy and chose to take ibrutinib orally. Two months after oral ibrutinib, ultrasound examination showed that pleural effusion completely disappeared. In the next one year, the patient had a routine follow-up and was in good condition. To our knowledge, this is the first report of ibrutinib in the treatment of chylothorax associated with CLL. Ibrutinib provides a more palliative treatment for elderly CLL patients with chylothorax.

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“…A retrospective review performed in a tertiary referral clinic suggested that surgery or trauma was the most common cause, with lymphoma or other malignancies accounting for only 16.7% of the cases [7]. Case reports in the literature have linked malignant causes of chylothorax to prostate carcinoma [8], gastric adenocarcinoma [9], mesothelioma [10], lymphomas [11–14], small cell lung cancer [15], and chronic lymphocytic leukemia [16]. The overall prognosis for solid tumor-associated chylothorax is poor, while prognosis is good for lymphoma-associated chylothorax if remission can be achieved [17].…”

Section: Introductionmentioning

confidence: 99%

Bilateral Chylothorax as a Unique Presentation of Pancreaticobiliary or Upper Gastrointestinal Cancer

Merza

Lung

Saadaldin

et al. 2019

Case Reports in Pulmonology

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Chylothorax presents as exudate with lymphocytic predominance and high triglyceride-low LDH levels, usually due to a traumatic disruption of the thoracic duct, possibly iatrogenic. Other causes include malignancy, sarcoidosis, goiter, AIDS, or tuberculosis. Here we present a case of a 66-year-old male who came in with cough and shortness of breath for few weeks. A week earlier, at an ED visit, he was diagnosed with pneumonia based on CT angiogram of the chest without contrast that showed bilateral pleural effusion and bilateral pulmonary infiltrates. The CT-guided placement of bilateral chest tube drained 1160 cc of creamy yellow fluid on the right and 1200 cc of creamy yellow fluid on the left. CT chest/abdomen/pelvis showed bilateral ground-glass opacities within the lungs and possible bony metastasis. A whole-body bone scan showed multiple bony metastatic lesions throughout the skeleton. IR guided bone biopsy suggested upper GI or pancreaticobiliary cancer. Venous ultrasound with Doppler of left upper extremity showed findings suggestive of a nonocclusive DVT of proximal/mid left subclavian vein which is difficult to compress. Eventually, malignancy-related DVT of the left subclavian/brachiocephalic vein was identified as the possible etiology for the bilateral chylothorax.

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Experiences in the treatment of refractory chylothorax associated with lymphoproliferative disorders

Cited by 13 publications

References 32 publications

Primary Pleural Extranodal Marginal Zone Lymphoma Presenting as Bilateral Chylothorax

Primary Pleural Extranodal Marginal Zone Lymphoma Presenting as Bilateral Chylothorax

Complete resolution of chylothorax with ibrutinib in chronic lymphocytic leukemia: a case report

Bilateral Chylothorax as a Unique Presentation of Pancreaticobiliary or Upper Gastrointestinal Cancer

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