A “low and slow” approach to successful medical treatment of primary cardiac lymphoma

Primary cardiac lymphomas (PCL) are very rare lymphoid malignancies that originate in the heart or pericardium. Their clinical diagnosis is often difficult, as they infrequently present with signs and symptoms consistent with cardiopulmonary conditions. Typically when B symptoms develop, (fever, weight loss, fatigue common in lymphoid malignancies), progressive heart failure will ensue. Antineoplastic treatment of PCL carries the risk of rapid tumor destruction, causing significant cardiovascular complications including life threatening arrhythmias, pericardial effusion or ventricular septal rupture. While chemotherapy is recommended to treat PCL, prognosis and response to therapy are impacted by the cardiovascular complications. In this instance, a low intensity initiation of chemotherapy followed by the standard full-dose regimen was able to achieve complete remission without cardiovascular complications. Patient monitoring in the Cardiac Intensive Care Unit (CICU) while undergoing initial cycles of chemotherapy may further offer the opportunity to institute lifesaving treatment when encountering the aforementioned cardiovascular complications.