Successful Use of Extracorporeal Membrane Oxygenation for Respiratory Failure Caused by Mediastinal Precursor T Lymphoblastic Lymphoma

Abstract

Precursor T lymphoblastic lymphoma (T-LBL) often manifests as a mediastinal mass sometimes compressing vital structures like vessels or large airways. This case was a 40-year-old male who developed T-LBL presenting as respiratory failure caused by mediastinal T-LBL. He presented with persistent life threatening hypoxia despite tracheal intubation. We successfully managed this respiratory failure using venovenous (VV) ECMO. Induction chemotherapy was started after stabilizing oxygenation and the mediastinal lesion shrank rapidly. Respiratory failure caused by compression of the central airway by tumor is an oncologic emergency. VV ECMO may be an effective way to manage this type of respiratory failure as a bridge to chemotherapy.

The Utility of Extracorporeal Membrane Oxygenation in Patients With Hematologic Malignancies: A Literature Review

“…Chemotherapy with Adriamycin, Vincristine, Cyclophosphamide, and Prednisolone was initiated on hospital day 3 for tumor debulking, after which the mediastinal mass rapidly decreased in size. This was associated with an improvement in oxygenation, and he was weaned from ECMO on hospital day 8 [23]. Subsequent consolidation therapy was administered during his hospital stay, and partial remission of the tumor was confirmed on hospital day 87.…”

“…Furthermore, Oto et al described the case of a 40-year-old male with chest pain and dyspnea due to a 12 cm by 7 cm mediastinal mass [23]. He underwent tracheal intubation followed immediately by urgent ECMO placement as the tumor completely obstructed the left main bronchus.…”

“…He underwent tracheal intubation followed immediately by urgent ECMO placement as the tumor completely obstructed the left main bronchus. Fine needle biopsy of the mediastinal tumor was performed, diagnosing precursor T lymphoblastic lymphoma [23]. Chemotherapy with Adriamycin, Vincristine, Cyclophosphamide, and Prednisolone was initiated on hospital day 3 for tumor debulking, after which the mediastinal mass rapidly decreased in size.…”

“…Subsequent consolidation therapy was administered during his hospital stay, and partial remission of the tumor was confirmed on hospital day 87. The patient proceeded to HSCT with favorable prognosis [23].…”

Extracorporeal membrane oxygenation support in patients with hematologic malignancies: to whom and when?

“…Because all 15 patients died in this previous study, negative impressions are inevitable with regard to ECMO in patients with HM. However, our patient shows potential benefit of ECMO in patients with HM can be realized if patients are adequately selected [ 2 , 3 ]. Wohlfarth et al [ 4 ] conducted a retrospective analysis of 14 Austrian patients with HM that received ECMO and reported more optimistic outcomes; seven achieved long-term disease-free survival.…”