0343: Obstructive cardiac tumor in Hodgkin’s lymphoma: course of cardiac involvement under emergency chemotherapy

Abstract

Cardiac involvement in Hodgkin’s disease (HD) is one of the least investigated subjects in cardiac oncology. Emergency chemotherapy is a rare necessity in Hodgkin’s disease, but life-threatening cardiac involvement is possible, compromising hemodynamic stability. We report a case of Hodgkin’s lymphoma which presented with acute obstructive left heart failure. It is about a 37 years old patient treated in 2000 for HD, type3, stage IVB medullar by chemotherapy (4MOPP+ABVD) followed by radiotherapy, and judged in complete remission. Few months ago, the patient presents a cardiac relapse, echocardiography revealed an enormous left atrial mass inducing a subtotal mitral obstruction confirmed by the tomodensitomety. After a multidisciplinary concertation we used the CEOP protocol (cyclophosphamide 650 mg/m 2 , etoposid100 mg/m 2 , oncovin 1,4 mg/m 2 , prednisone, 40 mg/m 2 ) associated to the conventional heart failure treatement. Under chemotherapy the evolution was favourable with amelioration of symptoms strengthen by regression of cardiac mass gradually in the weekly echocardiography checking after 4 cures. HD is not a steroid-sensitive disease, no single drug is rapidly efficient, and no recommendation is available in the literature regarding urgent cytoreduction. Therefore, if a decision for emergency chemotherapy is made, an aggressive combination may be recommended. In addition, newer agents resulting in improved cancer therapy outcomes might alter the prevalence and location of metastatic deposits to include more unusual disease sites, including intracardiac locations. Lymphomatous involvement of the heart, previously a rarity, is now being reported with greater frequency. The increased incidence might be partly a result of increased clinical awareness, improved imaging techniques. Adaptative chemotherapy can successfully improve the long term outcome of these patients.